=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356867824
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL MASANDAG DE GUZMAN LMT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2017
-----------------------------------------------------
Last Update Date | 08/16/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7111 FM 2920 RD STE NO113
-----------------------------------------------------
City | SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77379-2208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-538-2185
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5119 ROTH FOREST LN
-----------------------------------------------------
City | SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77389-4190
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-538-2185
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MT103240
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------