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General NPI Number Information
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NPI Number | 1851848790
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Entity Type | Organization
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Legal Business Name | FUSION MASSAGE & BODYWORK
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Dates
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Enumeration Date | 09/08/2016
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Last Update Date | 09/08/2016
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Provider Practice Location Address
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Address Line | 21703 KINGSLAND BLVD SUITE 101
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City | KATY
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State | TX
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Zip | 77450-2520
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Country | US
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Telephone | 832-465-5388
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Fax |
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Provider Business Mailing Address
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Address Line | 20810 UNION PARK CT
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City | KATY
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State | TX
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Zip | 77450-4158
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Country | US
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Telephone | 832-465-5388
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MS. ANGELIQUE M WARREN
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Credential | LMT
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Telephone | 832-465-5388
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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 | 041066
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License Number State | TX
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