Individual
BEAU NICHOLAS THIESEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CMT, CPT, CES
Contact information
Practice address
231 VILLAGE COMMONS BLVD, SUITE 19, CAMARILLO, CA 93012-7818
(805) 586-4694
Mailing address
231 VILLAGE COMMONS BLVD, SUITE 19, CAMARILLO, CA 93012-7818
(805) 586-4694
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
52963
CA
Other
Enumeration date
12/07/2012
Last updated
09/02/2016
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