Healthcare Provider Details

I. General information

NPI: 1235309592
Provider Name (Legal Business Name): VANCARLUS SONTELLE TENNISON RMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W ARBROOK SUITE 200
ARLINGTON TX
76015
US

IV. Provider business mailing address

800 W ARBROOK SUITE 200
ARLINGTON TX
76015
US

V. Phone/Fax

Practice location:
  • Phone: 214-460-7244
  • Fax:
Mailing address:
  • Phone: 214-460-7244
  • Fax: 817-467-9021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT017973
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: