Provider Demographics
NPI:1689055840
Name:MAGNUSSON, FREYA (CMT, CPT)
Entity Type:Individual
Prefix:MISS
First Name:FREYA
Middle Name:
Last Name:MAGNUSSON
Suffix:
Gender:F
Credentials:CMT, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2018 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-1119
Mailing Address - Country:US
Mailing Address - Phone:415-672-7166
Mailing Address - Fax:
Practice Address - Street 1:2018 31ST AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-1119
Practice Address - Country:US
Practice Address - Phone:415-672-7166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-13
Last Update Date:2015-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14788272255A2300X
CA35970225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer