Provider Demographics
NPI:1457411803
Name:SLEETH, ELIZABETH TIS (CMT, MA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:TIS
Last Name:SLEETH
Suffix:
Gender:F
Credentials:CMT, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-2364
Mailing Address - Country:US
Mailing Address - Phone:408-279-2863
Mailing Address - Fax:
Practice Address - Street 1:16275 LOS GATOS BLVD
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-4519
Practice Address - Country:US
Practice Address - Phone:408-402-0210
Practice Address - Fax:408-402-0510
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140008225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist