Provider Demographics
NPI:1336716646
Name:NEUROMUSCULAR TRANSFORMATIONS
Entity Type:Organization
Organization Name:NEUROMUSCULAR TRANSFORMATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MMT
Authorized Official - Phone:760-401-7968
Mailing Address - Street 1:4833 SANTA MONICA AVE UNIT 7840
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-2810
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4833 SANTA MONICA AVE UNIT 7840
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-2810
Practice Address - Country:US
Practice Address - Phone:760-401-7968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-06
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No282J00000XHospitalsReligious Nonmedical Health Care InstitutionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA72368OtherMEDICAL MASSAGE CERT