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General NPI Number Information
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NPI Number | 1841696804
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Entity Type | Organization
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Legal Business Name | JAVINTE MASSAGE
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Dates
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Enumeration Date | 11/18/2014
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Last Update Date | 02/19/2015
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Provider Practice Location Address
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Address Line | 6801 RUFE SNOW DR SUITE 404
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City | WATAUGA
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State | TX
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Zip | 76148-2348
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Country | US
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Telephone | 817-514-6055
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Fax |
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Provider Business Mailing Address
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Address Line | 6801 RUFE SNOW DR SUITE 404
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City | WATAUGA
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State | TX
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Zip | 76148-2348
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Country | US
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Telephone | 817-514-6055
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. VALERIE ELAINE KELSO- WASHINGTON
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Credential |
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Telephone | 817-514-6055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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