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General NPI Number Information
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NPI Number | 1164849386
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Entity Type | Organization
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Legal Business Name | THE MASSAGE CAFE
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Dates
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Enumeration Date | 03/26/2014
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Last Update Date | 03/26/2014
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Provider Practice Location Address
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Address Line | 3225 WOODLAND PARK DR APT 1123
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City | HOUSTON
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State | TX
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Zip | 77082-7626
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Country | US
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Telephone | 832-439-3291
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Fax |
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Provider Business Mailing Address
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Address Line | 3225 WOODLAND PARK DR APT 1123
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City | HOUSTON
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State | TX
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Zip | 77082-7626
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Country | US
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Telephone | 832-439-3291
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Fax |
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Authorized Official
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Title or Position | LICENSED MASSAGE THERAPIST
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Name | TAMELA ROLAND
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Credential |
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Telephone | 832-439-3291
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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 | MT109876
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License Number State | TX
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