Healthcare Provider Details

I. General information

NPI: 1063602456
Provider Name (Legal Business Name): LORENZO T. HUGHES SR. LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 12/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8908 E. 89TH STREET
KANSAS CITY MO
64138
US

IV. Provider business mailing address

10126 W 119TH ST
OVERLAND PARK KS
66213-1461
US

V. Phone/Fax

Practice location:
  • Phone: 816-876-9213
  • Fax:
Mailing address:
  • Phone: 913-339-9991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2005040446
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: