=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376878546
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RELAX
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2009
-----------------------------------------------------
Last Update Date | 10/06/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2024 WENNECA AVE
-----------------------------------------------------
City | FT. WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-453-5603
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2024 WENNECA AVE
-----------------------------------------------------
City | FT. WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-453-5603
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MASSAGE THERAPY
-----------------------------------------------------
Name | MS. TONYA TURNER
-----------------------------------------------------
Credential | LMT
-----------------------------------------------------
Telephone | 832-453-5603
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MT101445
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------