Provider Demographics
NPI:1295306397
Name:DEMPSEY, MADISON (CMT, B/S KINESIOLOGY)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:DEMPSEY
Suffix:
Gender:F
Credentials:CMT, B/S KINESIOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1373 MARRON VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:DULZURA
Mailing Address - State:CA
Mailing Address - Zip Code:91917-2105
Mailing Address - Country:US
Mailing Address - Phone:619-206-8664
Mailing Address - Fax:
Practice Address - Street 1:1373 MARRON VALLEY RD
Practice Address - Street 2:
Practice Address - City:DULZURA
Practice Address - State:CA
Practice Address - Zip Code:91917-2105
Practice Address - Country:US
Practice Address - Phone:619-206-8664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82992225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist