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NPI Code Detail

MEDICARE: LARRY WAYNE ROBERTSON LICENSED MASSAGE

MEDICARE: LARRY WAYNE ROBERTSON LICENSED MASSAGE
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
1225700000XMassage TherapistMT037344TX

General Provider Information

NPI Number : 1720868581
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARRY WAYNE ROBERTSON LICENSED MASSAGE
Provider Business Mailing Address
First Line : 116 E SOUTH ST
Second Line :
City : LONGVIEW
State : TX
Zip : 75601-7437
Country : US
Telephone Number : 903-230-1911
Fax Number :
Provider Business Practice Location Address
First Line : 116 E SOUTH ST
Second Line :
City : LONGVIEW
State : TX
Zip : 75601-7437
Country : US
Telephone Number : 903-230-1911
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2023
Last Update Date : 09/29/2023

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Directions to “ LARRY WAYNE ROBERTSON LICENSED MASSAGE” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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