MEDICARE: MRS. LYNESSA LESHA BROWN 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	MT117004	TX

General Provider Information

NPI Number	:	1639829815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LYNESSA LESHA BROWN LMT

Provider Business Mailing Address
First Line	:	4607 TIMBERGLEN RD APT 1928
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75287-5256
Country	:	US
Telephone Number	:	469-600-1239
Fax Number	:

Provider Business Practice Location Address
First Line	:	4607 TIMBERGLEN RD APT 1928
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75287-5256
Country	:	US
Telephone Number	:	469-600-1239
Fax Number	:

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

Provider Enumeration Date	:	03/28/2022
Last Update Date	:	03/28/2022

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