Healthcare Provider Details

I. General information

NPI: 1447536198
Provider Name (Legal Business Name): LAY YOUR HANDS ON ME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 E WHEATLAND RD
DUNCANVILLE TX
75116-4829
US

IV. Provider business mailing address

1414 SHILOH RD APT 4021
PLANO TX
75074-8257
US

V. Phone/Fax

Practice location:
  • Phone: 214-718-4177
  • Fax: 972-941-6541
Mailing address:
  • Phone: 214-718-4177
  • Fax: 972-941-6547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberMT039221
License Number StateTX

VIII. Authorized Official

Name: MR. WAYNE ALTON PAYTON I
Title or Position: OWNER/MEDICAL MASSAGE PRACTIONER
Credential: LMT.,MMP
Phone: 214-718-4177