Provider Demographics
NPI:1457136715
Name:FLANAGAN, EMMA ANTOINETTE (CMT)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:ANTOINETTE
Last Name:FLANAGAN
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 1:2853 EL NIDO DR
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-4917
Mailing Address - Country:US
Mailing Address - Phone:626-660-8010
Mailing Address - Fax:
Practice Address - Street 1:2853 EL NIDO DR
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-4917
Practice Address - Country:US
Practice Address - Phone:626-660-8010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75958225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist