Healthcare Provider Details

I. General information

NPI: 1902714561
Provider Name (Legal Business Name): ADRIANA ACOSTA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E DALLAS RD STE 118
GRAPEVINE TX
76051-1149
US

IV. Provider business mailing address

400 E DALLAS RD STE 118
GRAPEVINE TX
76051-1149
US

V. Phone/Fax

Practice location:
  • Phone: 469-608-9836
  • Fax:
Mailing address:
  • Phone: 469-608-9836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number139507
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: