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General NPI Number Information
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NPI Number | 1609390517
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Entity Type | Organization
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Legal Business Name | MASSAGE INNOVATION, LLC
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Dates
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Enumeration Date | 08/01/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4615 SOUTHWEST FWY STE 135
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City | HOUSTON
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State | TX
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Zip | 77027-7106
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Country | US
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Telephone | 713-449-5493
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Fax | 713-662-9103
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Provider Business Mailing Address
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Address Line | 4615 SOUTHWEST FWY STE 135
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City | HOUSTON
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State | TX
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Zip | 77027-7106
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Country | US
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Telephone | 713-449-5493
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Fax | 713-662-9103
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Authorized Official
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Title or Position | LICENSED MASSAGE THERAPIST/ OWNER
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Name | H. RENE OLIVAREZ
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Credential |
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Telephone | 713-449-5493
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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 | MT031907
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License Number State | TX
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