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General NPI Number Information
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NPI Number | 1083953293
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Entity Type | Individual
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Provider Name | JULIO MALACARA JR. MT
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Gender | Male
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Dates
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Enumeration Date | 02/07/2013
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Last Update Date | 02/07/2013
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Provider Practice Location Address
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Address Line | 101 E JONES ST
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City | SHERMAN
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State | TX
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Zip | 75090-7120
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Country | US
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Telephone | 903-893-6222
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Fax |
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Provider Business Mailing Address
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Address Line | 408 N WOODS ST
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City | SHERMAN
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State | TX
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Zip | 75092-5623
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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 | MT023121
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License Number State | TX
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