Healthcare Provider Details

I. General information

NPI: 1629874615
Provider Name (Legal Business Name): SANDRA ZAVALA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 PRESTON RD STE 300
FRISCO TX
75034-9060
US

IV. Provider business mailing address

3528 RED DEER LN
MELISSA TX
75454-3053
US

V. Phone/Fax

Practice location:
  • Phone: 214-207-3773
  • Fax:
Mailing address:
  • Phone: 214-207-3773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number032157
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: