MEDICARE: SETOUDEH STELLA REICHLE MT, MI

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	MT018043	TX

General Provider Information

NPI Number	:	1619552635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SETOUDEH STELLA REICHLE MT, MI

Provider Business Mailing Address
First Line	:	4304 LAGUNA DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75287-4013
Country	:	US
Telephone Number	:	214-494-9642
Fax Number	:

Provider Business Practice Location Address
First Line	:	4304 LAGUNA DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75287-4013
Country	:	US
Telephone Number	:	214-494-9642
Fax Number	:

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

Provider Enumeration Date	:	03/11/2021
Last Update Date	:	03/15/2026

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