Healthcare Provider Details

I. General information

NPI: 1376015438
Provider Name (Legal Business Name): MADELYNNE FIMPLE LMT/MMP, OTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2018
Last Update Date: 12/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8057 WHITEHART ST
FRISCO TX
75035-3166
US

IV. Provider business mailing address

8057 WHITEHART ST
FRISCO TX
75035-3166
US

V. Phone/Fax

Practice location:
  • Phone: 469-406-9123
  • Fax:
Mailing address:
  • Phone: 469-406-9123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberMT107685
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMT107685
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberMT107685
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberMT107685
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT107685
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: