MEDICARE: MR. CARLOS M GUERRERO 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	MT143117	TX

General Provider Information

NPI Number	:	1447075569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CARLOS M GUERRERO LMT

Provider Business Mailing Address
First Line	:	5900 BALCONES DR STE 100
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-4298
Country	:	US
Telephone Number	:	281-750-1128
Fax Number	:

Provider Business Practice Location Address
First Line	:	5715 MICAH LN
Second Line	:
City	:	ROSENBERG
State	:	TX
Zip	:	77471-1981
Country	:	US
Telephone Number	:	281-750-1128
Fax Number	:

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

Provider Enumeration Date	:	11/22/2024
Last Update Date	:	11/25/2024

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