Susan M McMahon

Individual provider Active NPI Massage Therapist · Frazier Park, CA

NPI 1447589684 · NPPES record last updated Dec 17, 2009

Key facts

NPI
1447589684
Entity type
Individual (NPI type 1)
Primary specialty
Massage Therapist 225700000X
License
PENDING (CA)
Practice address
4116 Alcot Trail
Frazier Park, CA 93225-6775
Phone
(661) 338-4805
NPI assigned
Dec 17, 2009
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
PENDINGCAMDDentist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X PENDING CA Yes

Addresses

Primary practice location

4116 Alcot Trail
Frazier Park, CA 93225-6775

Mailing address

PO Box 1375
Frazier Park, CA 93225-1375
Phone (661) 338-4805

Other providers in Frazier Park, CA

All providers in Frazier Park, CA · Massage Therapist in California

Sources for this page

Verify at the official NPI Registry.