MEDICARE: CHRISTOPHER LONGORIA LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MT107966	TX

General Provider Information

NPI Number	:	1104458892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER LONGORIA LMT

Provider Business Mailing Address
First Line	:	4017 VICTORY DR APT 258
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-7556
Country	:	US
Telephone Number	:	210-548-9780
Fax Number	:

Provider Business Practice Location Address
First Line	:	4017 VICTORY DR APT 258
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-7556
Country	:	US
Telephone Number	:	210-548-9780
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2020
Last Update Date	:	02/10/2020

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Directions to “ CHRISTOPHER LONGORIA LMT” Practice Location

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