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General NPI Number Information
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NPI Number | 1720587538
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Entity Type | Organization
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Legal Business Name | SOL MEDICAL MASSAGE INC
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Dates
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Enumeration Date | 02/07/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 4666 MCDERMOTT RD SUITE 100
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City | PLANO
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State | TX
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Zip | 75024
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Country | US
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Telephone | 972-668-6868
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 118381
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City | CARROLLTON
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State | TX
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Zip | 75011-8381
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Country | US
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Telephone | 469-701-1097
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Fax |
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Authorized Official
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Title or Position | MASSAGE PRACTICIONER
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Name | MRS. LETICIA REYES
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Credential | LICENSED MASSAGE
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Telephone | 469-701-1097
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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 | MT102405
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License Number State | TX
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