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General NPI Number Information
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NPI Number | 1548831779
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Entity Type | Individual
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Provider Name | EBONY MARKS LMT
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Gender | Female
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Dates
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Enumeration Date | 07/08/2021
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Last Update Date | 07/08/2021
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Provider Practice Location Address
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Address Line | 947 GESSNER RD STE B-275, UNIT 210
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City | HOUSTON
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State | TX
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Zip | 77024-2516
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Country | US
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Telephone | 832-827-3370
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Fax |
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Provider Business Mailing Address
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Address Line | 1822 BARKER CYPRESS RD APT 2607
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City | HOUSTON
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State | TX
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Zip | 77084-4574
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Country | US
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Telephone | 832-647-0136
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2021016587
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT135251
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License Number State | TX
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