Individual
SANTISOUK PROUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CMT
Contact information
Practice address
8278 W LAKE PLEASANT PKWY, PEORIA, AZ 85382-7441
(510) 384-5817
Mailing address
19401 N 15TH PL, PHOENIX, AZ 85024-3625
(510) 384-5817
Taxonomy
Speciality
Code
Description
License number
State
163WM1400X
Nurse Massage Therapist (NMT)
Primary
MT
AZ
Other
Enumeration date
04/22/2024
Last updated
02/04/2026
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