Provider Demographics
NPI:1013273762
Name:ATHANS, JOY LARAINE (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:LARAINE
Last Name:ATHANS
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3502 1ST AVE
Mailing Address - Street 2:APARTMENT 12
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4884
Mailing Address - Country:US
Mailing Address - Phone:619-316-6714
Mailing Address - Fax:
Practice Address - Street 1:2602 1ST AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-6529
Practice Address - Country:US
Practice Address - Phone:619-316-6714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA222461163W00000X
CA3090225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No163W00000XNursing Service ProvidersRegistered Nurse