Healthcare Provider Details

I. General information

NPI: 1891407607
Provider Name (Legal Business Name): 180 MASSAGE THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2022
Last Update Date: 12/23/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10600 MONTWOOD DR STE 101
EL PASO TX
79935-2713
US

IV. Provider business mailing address

10600 MONTWOOD DR STE 101
EL PASO TX
79935-2713
US

V. Phone/Fax

Practice location:
  • Phone: 915-479-6534
  • Fax:
Mailing address:
  • Phone: 914-479-6534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MONICA I GARZA
Title or Position: MASSAGE THERAPIST
Credential:
Phone: 152-222-4615