Healthcare Provider Details

I. General information

NPI: 1821799800
Provider Name (Legal Business Name): STEPHANIE BUSS LICENSED MASSAGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 JOHNSON ST
BIG SPRING TX
79720-2820
US

IV. Provider business mailing address

3223 AUBURN AVE
BIG SPRING TX
79720-3501
US

V. Phone/Fax

Practice location:
  • Phone: 580-967-0742
  • Fax:
Mailing address:
  • Phone: 580-374-2748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT148018
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: