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General NPI Number Information
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NPI Number | 1922734482
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Entity Type | Organization
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Legal Business Name | LOTUS SPA & SALON, LLC
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Dates
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Enumeration Date | 07/27/2022
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Last Update Date | 07/27/2022
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Provider Practice Location Address
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Address Line | 6115 CAMP BOWIE BLVD STE 154
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City | FORT WORTH
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State | TX
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Zip | 76116-5544
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Country | US
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Telephone | 817-386-7865
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Fax |
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Provider Business Mailing Address
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Address Line | 6115 CAMP BOWIE BLVD STE 154
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City | FORT WORTH
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State | TX
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Zip | 76116-5544
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Country | US
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Telephone | 817-386-7865
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | RUTH STOUT
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Credential | LMT
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Telephone | 817-386-7865
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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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Taxonomy #2
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number |
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License Number State |
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