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General NPI Number Information
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NPI Number | 1780204255
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Entity Type | Organization
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Legal Business Name | DIVINE TOUCH TX PLLC
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Dates
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Enumeration Date | 04/24/2020
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Last Update Date | 04/24/2020
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Provider Practice Location Address
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Address Line | 4008 E STAN SCHLUETER LOOP STE 108
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City | KILLEEN
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State | TX
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Zip | 76542-8537
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Country | US
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Telephone | 254-245-8003
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Fax |
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Provider Business Mailing Address
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Address Line | 6312 ALABASTER DR
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City | KILLEEN
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State | TX
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Zip | 76542-5729
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Country | US
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Telephone | 254-702-6864
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Fax |
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Authorized Official
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Title or Position | BUSINESS OWNER/LMT
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Name | MRS. MICHELLE JANAY WHIGHAM
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Credential | LMT
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Telephone | 254-702-6864
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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 |
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License Number State |
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