Healthcare Provider Details

I. General information

NPI: 1306384755
Provider Name (Legal Business Name): YOLANDA TEXIDOR LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 JENKINS RD
ROSSVILLE GA
30741-4186
US

IV. Provider business mailing address

354 JENKINS RD
ROSSVILLE GA
30741-4186
US

V. Phone/Fax

Practice location:
  • Phone: 470-439-6114
  • Fax:
Mailing address:
  • Phone: 470-439-6114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number012918
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number012918
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number132
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: