=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811436462
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 3RS MASSAGE THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2017
-----------------------------------------------------
Last Update Date | 02/15/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1201 AIRPORT FWY SUITE 20
-----------------------------------------------------
City | EULESS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76040-4177
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-454-6802
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2715 S COOPER ST #248
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76015-2409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-454-6802
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LINDA A SIMMONS
-----------------------------------------------------
Credential | LMT
-----------------------------------------------------
Telephone | 817-454-6802
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171W00000X
-----------------------------------------------------
Taxonomy Name | Contractor
-----------------------------------------------------
License Number | MT113173
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------