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General NPI Number Information
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NPI Number | 1932880952
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Entity Type | Individual
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Provider Name | CHERE LECOLE ROEBUCK LMT
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Gender | Female
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Dates
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Enumeration Date | 07/31/2023
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Last Update Date | 07/31/2023
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Provider Practice Location Address
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Address Line | 5930 W I 20
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City | ARLINGTON
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State | TX
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Zip | 76017-1074
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Country | US
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Telephone | 817-919-7805
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Fax |
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Provider Business Mailing Address
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Address Line | 714 KINGSTON DR
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City | GRAND PRAIRIE
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State | TX
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Zip | 75051-4446
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Country | US
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Telephone | 817-455-5620
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Fax |
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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 | MT133382
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License Number State | TX
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