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General NPI Number Information
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NPI Number | 1083251318
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Entity Type | Individual
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Provider Name | RAEANN MASK LMT
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Gender | Female
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Dates
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Enumeration Date | 12/05/2019
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Last Update Date | 12/05/2019
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Provider Practice Location Address
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Address Line | 3501 W. 45TH ST SUITE T
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City | AMARILLO
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State | TX
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Zip | 79109
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Country | US
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Telephone | 806-355-3000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7339
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City | AMARILLO
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State | TX
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Zip | 79114-7339
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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 |
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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 | MT122618
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License Number State | TX
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