MEDICARE: KATHERYNE TOBIN JAMES HHP, CMT, MQT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	51874	CA

General Provider Information

NPI Number	:	1619508538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERYNE TOBIN JAMES HHP, CMT, MQT

Provider Business Mailing Address
First Line	:	1501 NAGLEE AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95126-2012
Country	:	US
Telephone Number	:	408-234-5902
Fax Number	:

Provider Business Practice Location Address
First Line	:	1165 LINCOLN AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125-3043
Country	:	US
Telephone Number	:	408-234-5902
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2020
Last Update Date	:	01/29/2020

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