Provider Demographics
NPI:1396525473
Name:VALENCIA, JOSE S (LICENSE MASSAGE THER)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:S
Last Name:VALENCIA
Suffix:
Gender:M
Credentials:LICENSE MASSAGE THER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 E KONA DR
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-5023
Mailing Address - Country:US
Mailing Address - Phone:480-238-8439
Mailing Address - Fax:
Practice Address - Street 1:3940 S ALMA SCHOOL RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-4513
Practice Address - Country:US
Practice Address - Phone:480-435-9546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ09085225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist