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General NPI Number Information
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NPI Number | 1639828767
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Entity Type | Individual
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Provider Name | TIYLER LISA BRICE
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Gender | Female
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Dates
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Enumeration Date | 03/23/2022
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Last Update Date | 03/23/2022
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Provider Practice Location Address
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Address Line | 1308 ORCHID DR APT A
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City | PRINCETON
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State | TX
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Zip | 75407-1159
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Country | US
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Telephone | 214-228-2929
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Fax |
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Provider Business Mailing Address
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Address Line | 550 N CENTRAL EXPY UNIT 524
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City | MCKINNEY
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State | TX
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Zip | 75070-0027
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Country | US
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Telephone | 214-228-2929
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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 | 120993
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License Number State | TX
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