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Individual

PHYLLIS DOUGLASS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CAMTC# 56843

Contact information

Practice address
340 S GLENDORA AVE, GLENDORA, CA 91741-6255
(909) 967-0246
Mailing address
1901 CANOPY LN, LA VERNE, CA 91750-3514
(909) 967-0246

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
56843
CA

Other

Enumeration date
11/10/2020
Last updated
11/10/2020
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