Provider Demographics
NPI:1851029797
Name:POSCHWATTA, ARYEL LEE (CMT,)
Entity Type:Individual
Prefix:
First Name:ARYEL
Middle Name:LEE
Last Name:POSCHWATTA
Suffix:
Gender:F
Credentials:CMT,
Other - Prefix:
Other - First Name:ARYEL
Other - Middle Name:LEE
Other - Last Name:THAYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMT
Mailing Address - Street 1:1077 MAYWOOD LN APT 514
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-6578
Mailing Address - Country:US
Mailing Address - Phone:925-335-6364
Mailing Address - Fax:
Practice Address - Street 1:1077 MAYWOOD LN
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-6577
Practice Address - Country:US
Practice Address - Phone:925-335-6364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-09
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374J00000X
CA72898225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty