Provider Demographics
NPI:1730837238
Name:MOBLEY, NYSSA NICOLE (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:NYSSA
Middle Name:NICOLE
Last Name:MOBLEY
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 E SHAW AVE APT 137
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7821
Mailing Address - Country:US
Mailing Address - Phone:310-738-3352
Mailing Address - Fax:
Practice Address - Street 1:1250 E SHAW AVE APT 137
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7821
Practice Address - Country:US
Practice Address - Phone:310-738-3352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2022-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73889225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist