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General NPI Number Information
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NPI Number | 1922249473
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Entity Type | Individual
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Provider Name | MICHAEL R OSBORNE JR. LMT
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Gender | Male
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Dates
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Enumeration Date | 03/12/2009
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Last Update Date | 03/12/2009
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Provider Practice Location Address
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Address Line | 503 S MAIN SUITE 103
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City | SAN ANTONIO
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State | TX
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Zip | 78204-1207
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Country | US
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Telephone | 210-723-6723
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Fax | 210-699-0005
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Provider Business Mailing Address
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Address Line | PO BOX 690665
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City | SAN ANTONIO
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State | TX
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Zip | 78269-0665
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Country | US
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Telephone | 210-723-6723
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Fax | 210-699-0005
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | LMT 018858
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License Number State | TX
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