Provider Demographics
NPI:1063028603
Name:HUGHES, KELLEY ELIZABETH (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:ELIZABETH
Last Name:HUGHES
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26123 BOUQUET CANYON RD APT 203
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-2918
Mailing Address - Country:US
Mailing Address - Phone:949-244-9467
Mailing Address - Fax:
Practice Address - Street 1:23123 BOUQUET CYN RD
Practice Address - Street 2:203
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-9135
Practice Address - Country:US
Practice Address - Phone:949-244-9467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80422405300000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No405300000XOther Service ProvidersPrevention Professional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA80422OtherCERTIFICATION
CA80422OtherMASSAGE THERAPIST
CA80422OtherCERTIFICATION MASSAGE THERAPIST