Provider Demographics
NPI:1720787914
Name:RICHOFSKY, MEGAN KIM (CMT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:KIM
Last Name:RICHOFSKY
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:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:STEVINSON
Mailing Address - State:CA
Mailing Address - Zip Code:95374-0095
Mailing Address - Country:US
Mailing Address - Phone:408-892-1428
Mailing Address - Fax:
Practice Address - Street 1:1526 LANDER AVE
Practice Address - Street 2:
Practice Address - City:STEVINSON
Practice Address - State:CA
Practice Address - Zip Code:95374-9602
Practice Address - Country:US
Practice Address - Phone:408-892-1428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82348225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist