Healthcare Provider Details

I. General information

NPI: 1467281675
Provider Name (Legal Business Name): CHINDAWAN PREEPREM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 S PRESTON RD STE 630
PROSPER TX
75078-1907
US

IV. Provider business mailing address

4949 PRINTERS WAY APT 362
FRISCO TX
75033-3637
US

V. Phone/Fax

Practice location:
  • Phone: 469-955-2858
  • Fax:
Mailing address:
  • Phone: 469-955-2858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT138359
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: