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General NPI Number Information
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NPI Number | 1629891635
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Entity Type | Individual
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Provider Name | ROSA SAIDEL LMT MLD
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Gender | Female
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Dates
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Enumeration Date | 11/07/2024
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 1010 W JASPER DR STE 6
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City | KILLEEN
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State | TX
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Zip | 76542-1328
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Country | US
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Telephone | 252-543-9237
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Fax |
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Provider Business Mailing Address
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Address Line | 1254 HONEYSUCKLE DR
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City | KILLEEN
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State | TX
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Zip | 76549-3548
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Country | US
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Telephone | 484-767-7274
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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 | MT124522
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License Number State | TX
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