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General NPI Number Information
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NPI Number | 1629417225
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Entity Type | Organization
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Legal Business Name | TOTAL BODYWORK, THERAPEUTIC & MEDICAL MASSAGE
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Dates
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Enumeration Date | 06/18/2013
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Last Update Date | 06/18/2013
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Provider Practice Location Address
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Address Line | 525 W NOLANA AVE STE D
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City | MCALLEN
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State | TX
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Zip | 78504-3029
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Country | US
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Telephone | 956-686-7986
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Fax | 956-686-7986
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Provider Business Mailing Address
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Address Line | 525 W NOLANA AVE STE D
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City | MCALLEN
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State | TX
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Zip | 78504-3029
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Country | US
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Telephone | 956-686-7986
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Fax | 956-686-7986
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Authorized Official
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Title or Position | OWNER/LICENSE MASSAGE THERAPIST
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Name | MRS. YADIRA LOPEZ
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Credential | LMT
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Telephone | 956-655-4002
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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 | MT116418
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License Number State | TX
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