MEDICARE: BILLIE S LYDE MASSAGE THERAPIST

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	MT013167	TX

General Provider Information

NPI Number	:	1710849625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BILLIE S LYDE MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	106 N DENTON TAP RD STE 210-353
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019-2138
Country	:	US
Telephone Number	:	469-569-7918
Fax Number	:

Provider Business Practice Location Address
First Line	:	14330 MIDWAY RD STE 119
Second Line	:
City	:	FARMERS BRANCH
State	:	TX
Zip	:	75244-3513
Country	:	US
Telephone Number	:	469-569-7918
Fax Number	:

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

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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Directions to “ BILLIE S LYDE MASSAGE THERAPIST” Practice Location

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