Provider Demographics
NPI:1679939094
Name:EKAMA, TALITHA (CMTPT, ANMT, LMT)
Entity Type:Individual
Prefix:
First Name:TALITHA
Middle Name:
Last Name:EKAMA
Suffix:
Gender:F
Credentials:CMTPT, ANMT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5104 E VAN BUREN ST
Mailing Address - Street 2:APT 1151
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-7013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:115 W 6TH ST
Practice Address - Street 2:SUITE 116
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-3715
Practice Address - Country:US
Practice Address - Phone:323-686-2668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20660225700000X
CA42549225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist