MEDICARE: LISA VILLALBOZ 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	111N00000X	Chiropractor	20-1764594	TX
2	174400000X	Specialist	MT032837	TX

General Provider Information

NPI Number	:	1942525472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA VILLALBOZ MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	815 PLANTATION DR
Second Line	:	SUITE 160
City	:	RICHMOND
State	:	TX
Zip	:	77406-5038
Country	:	US
Telephone Number	:	832-595-6001
Fax Number	:	832-595-6003

Provider Business Practice Location Address
First Line	:	815 PLANTATION DR
Second Line	:	SUITE 160
City	:	RICHMOND
State	:	TX
Zip	:	77406-5038
Country	:	US
Telephone Number	:	832-595-6001
Fax Number	:	832-595-6003

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

Provider Enumeration Date	:	03/27/2010
Last Update Date	:	03/27/2010

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