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General NPI Number Information
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NPI Number | 1003136094
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Entity Type | Individual
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Provider Name | ANETHIA CRISTAL LOVE LMT
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Gender | Female
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Dates
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Enumeration Date | 06/02/2010
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Last Update Date | 01/17/2024
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Provider Practice Location Address
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Address Line | 7035 W TIDWELL RD BLDG J100A
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City | HOUSTON
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State | TX
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Zip | 77092-2054
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Country | US
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Telephone | 832-275-3000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 682983
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City | HOUSTON
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State | TX
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Zip | 77268-2983
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Country | US
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Telephone | 832-651-8486
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT101345
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License Number State | TX
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