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General NPI Number Information
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NPI Number | 1649507179
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Entity Type | Individual
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Provider Name | MRS. SHEILA JEAN MISTRIC
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Gender | Female
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Dates
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Enumeration Date | 11/04/2009
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Last Update Date | 11/04/2009
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Provider Practice Location Address
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Address Line | 24563 CLARK RD
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City | MONTGOMERY
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State | TX
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Zip | 77316-3876
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Country | US
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Telephone | 936-597-4197
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Fax |
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Provider Business Mailing Address
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Address Line | 24555 CLARK RD
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City | MONTGOMERY
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State | TX
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Zip | 77316
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Country | US
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Telephone | 936-597-4197
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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 | MT109193
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License Number State | TX
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