Provider Demographics
NPI:1043091846
Name:GALEEVA, ANASTASIA ILDAROVNA (LMT)
Entity type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:ILDAROVNA
Last Name:GALEEVA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:ILDAROVNA
Other - Last Name:ANASTASIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:39 QUAIL CT STE 205
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5570
Mailing Address - Country:US
Mailing Address - Phone:925-542-6474
Mailing Address - Fax:
Practice Address - Street 1:39 QUAIL CT STE 205
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5570
Practice Address - Country:US
Practice Address - Phone:925-542-6474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68588225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist