Individual
KELLY MARIE CARPENTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CMT
Contact information
Practice address
2075 LINCOLN AVE, SAN JOSE, CA 95125-3513
(669) 235-7754
Mailing address
PO BOX 8036, SAN JOSE, CA 95155-8036
(669) 235-7754
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
75185
CA
Other
Enumeration date
05/31/2018
Last updated
05/31/2018
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