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General NPI Number Information
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NPI Number | 1689801003
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Entity Type | Individual
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Provider Name | THERESA MARIE FENNESSEY LMT
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Gender | Female
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Dates
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Enumeration Date | 06/11/2009
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Last Update Date | 12/02/2010
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Provider Practice Location Address
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Address Line | 5818 BEVERLYHILL ST SUITE 100
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City | HOUSTON
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State | TX
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Zip | 77057-6710
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Country | US
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Telephone | 713-435-0070
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Fax |
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Provider Business Mailing Address
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Address Line | 7911 FAWN TERRACE DR
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City | HOUSTON
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State | TX
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Zip | 77071-2720
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Country | US
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Telephone | 713-435-0070
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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 | MT031281
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MT031281
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License Number State | TX
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