MEDICARE: FUNTESIA SMITH

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	MT142546	TX

General Provider Information

NPI Number	:	1487549291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FUNTESIA SMITH

Provider Business Mailing Address
First Line	:	11133 SHADY TRL # 470
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75229-4617
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11133 SHADY TRL # 470
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75229-4617
Country	:	US
Telephone Number	:	214-807-6778
Fax Number	:	888-830-8403

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

Provider Enumeration Date	:	06/11/2025
Last Update Date	:	06/11/2025

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Directions to “ FUNTESIA SMITH ” Practice Location

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