Provider Demographics
NPI:1447637376
Name:MATSUDA, HOPE (MT CCHT)
Entity type:Individual
Prefix:MS
First Name:HOPE
Middle Name:
Last Name:MATSUDA
Suffix:
Gender:F
Credentials:MT CCHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8168 FLORENTINE RD.
Mailing Address - Street 2:SERENITY WELLNESS
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314
Mailing Address - Country:US
Mailing Address - Phone:928-775-5066
Mailing Address - Fax:928-775-5066
Practice Address - Street 1:8168 FLORENTINE RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:83614
Practice Address - Country:US
Practice Address - Phone:928-775-5066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ#MT-19301225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist