Provider Demographics
NPI:1003405416
Name:MANON, KRISTIN LEIGH (CMT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LEIGH
Last Name:MANON
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 1:15724 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91708-9300
Mailing Address - Country:US
Mailing Address - Phone:909-573-5188
Mailing Address - Fax:
Practice Address - Street 1:15724 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91708-9300
Practice Address - Country:US
Practice Address - Phone:909-573-5188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81854225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty