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General NPI Number Information
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NPI Number | 1306335575
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Entity Type | Organization
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Legal Business Name | DESTINY LMT
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Dates
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Enumeration Date | 05/03/2018
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Last Update Date | 05/03/2018
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Provider Practice Location Address
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Address Line | 23221 ALDINE WESTFIELD RD STE 724
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City | SPRING
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State | TX
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Zip | 77373-8030
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Country | US
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Telephone | 281-975-7665
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 541012
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City | HOUSTON
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State | TX
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Zip | 77254-1012
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Country | US
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Telephone | 281-975-7665
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | DESTINY BROWN
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Credential | LMT
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Telephone | 281-975-7665
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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 | MT123642
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License Number State | TX
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