MEDICARE: MISS HAYLEY BENHAM BANTEAUX 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	120710	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LMT	OTHER	TX	MASSAGE THERAPY
2	7426	OTHER	NM	LICENSED MASSAGE THERAPIST

General Provider Information

NPI Number	:	1730426917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS HAYLEY BENHAM BANTEAUX LMT

Provider Business Mailing Address
First Line	:	4400 W UNIVERSITY BLVD APT 19111
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75209-3892
Country	:	US
Telephone Number	:	505-385-4042
Fax Number	:

Provider Business Practice Location Address
First Line	:	4807 W LOVERS LN STE 309
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75209-3137
Country	:	US
Telephone Number	:	505-385-4042
Fax Number	:

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

Provider Enumeration Date	:	01/08/2013
Last Update Date	:	05/12/2026

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Directions to “ MISS HAYLEY BENHAM BANTEAUX LMT” Practice Location

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