Provider Demographics
NPI:1225551443
Name:STRESSAGE THERAPY
Entity Type:Organization
Organization Name:STRESSAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPORTS REHABILITATION THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:619-519-3632
Mailing Address - Street 1:8300 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-9323
Mailing Address - Country:US
Mailing Address - Phone:619-622-1963
Mailing Address - Fax:
Practice Address - Street 1:8300 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-9323
Practice Address - Country:US
Practice Address - Phone:619-622-1963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No251E00000XAgenciesHome HealthGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive Care
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA69882OtherMASSAGE THERAPIST