Provider Demographics
NPI:1063643302
Name:SCHAMBECK, MARISA EDITH (CMT)
Entity Type:Individual
Prefix:MRS
First Name:MARISA
Middle Name:EDITH
Last Name:SCHAMBECK
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 E YOSEMITE AVE
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-5004
Mailing Address - Country:US
Mailing Address - Phone:209-823-7400
Mailing Address - Fax:209-823-1192
Practice Address - Street 1:1360 E YOSEMITE AVE
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-5004
Practice Address - Country:US
Practice Address - Phone:209-823-7400
Practice Address - Fax:209-823-1192
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3900911225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist