Provider Demographics
NPI:1184485955
Name:PERRY, MYESHA NICOLE (CMP)
Entity type:Individual
Prefix:
First Name:MYESHA
Middle Name:NICOLE
Last Name:PERRY
Suffix:
Gender:F
Credentials:CMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 FALLWATER LN
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-7402
Mailing Address - Country:US
Mailing Address - Phone:916-693-5224
Mailing Address - Fax:
Practice Address - Street 1:4719 MANZANITA AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0822
Practice Address - Country:US
Practice Address - Phone:916-693-5224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61003225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist