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General NPI Number Information
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NPI Number | 1073922993
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Entity Type | Organization
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Legal Business Name | KATHY CLINTON LMT
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Dates
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Enumeration Date | 08/05/2014
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Last Update Date | 08/05/2014
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Provider Practice Location Address
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Address Line | 1333 ALDER TREE LN
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City | ROYSE CITY
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State | TX
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Zip | 75189-8165
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Country | US
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Telephone | 972-220-8783
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Fax |
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Provider Business Mailing Address
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Address Line | 1333 ALDER TREE LN
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City | ROYSE CITY
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State | TX
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Zip | 75189-8165
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MASSAGE THERAPIST
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Name | KATHY CLINTON
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Credential | LMT
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Telephone | 972-220-8783
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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 | MT101471
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License Number State | TX
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