Provider Demographics
NPI:1669984837
Name:CARNES, MICHAEL SCOTT (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SCOTT
Last Name:CARNES
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN MANUEL
Mailing Address - State:AZ
Mailing Address - Zip Code:85631-1406
Mailing Address - Country:US
Mailing Address - Phone:480-620-6989
Mailing Address - Fax:
Practice Address - Street 1:205 W GIACONDA WAY STE 105
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-4350
Practice Address - Country:US
Practice Address - Phone:520-204-1479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-28
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-24144225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist