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General NPI Number Information
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NPI Number | 1518763499
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Entity Type | Organization
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Legal Business Name | ELITE WELLNESS WACO LLC
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Dates
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Enumeration Date | 02/21/2025
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Last Update Date | 02/21/2025
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Provider Practice Location Address
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Address Line | 1217 S HEWITT DR
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City | HEWITT
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State | TX
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Zip | 76643-3200
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Country | US
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Telephone | 254-723-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 1217 S HEWITT DR
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City | HEWITT
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State | TX
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Zip | 76643-3200
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Country | US
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Telephone | 254-723-2400
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | MARQUIS MANGRUM
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Credential | LMT
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Telephone | 254-723-2400
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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 |
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License Number State |
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