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General NPI Number Information
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NPI Number | 1558841627
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Entity Type | Organization
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Legal Business Name | BACK 2 NORMAL MASSAGE PLLC
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Dates
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Enumeration Date | 08/17/2018
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 3401 CUSTER RD STE 181
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City | PLANO
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State | TX
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Zip | 75023-7599
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Country | US
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Telephone | 833-962-7724
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Fax | 469-969-0098
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Provider Business Mailing Address
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Address Line | 956 LONGHORN DR
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City | PLANO
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State | TX
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Zip | 75023-4446
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Country | US
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Telephone | 972-467-4071
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Fax | 469-969-0098
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Authorized Official
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Title or Position | OWNER
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Name | PIERRE DEANTONIO ROBINSON
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Credential | LMT115919
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Telephone | 972-467-4071
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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 | LMT115919
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License Number State | TX
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