Provider Demographics
NPI:1538810858
Name:PALFREYMAN, KACEY MARK (CMT)
Entity type:Individual
Prefix:
First Name:KACEY
Middle Name:MARK
Last Name:PALFREYMAN
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23411 SUMMERFIELD APT 68A
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2862
Mailing Address - Country:US
Mailing Address - Phone:949-672-8768
Mailing Address - Fax:
Practice Address - Street 1:23411 SUMMERFIELD APT 68A
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-2862
Practice Address - Country:US
Practice Address - Phone:949-672-8768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84445225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty