MEDICARE: ARIEL AMBER-LYNN CARMACK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MT116825	TX

General Provider Information

NPI Number	:	1205486867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARIEL AMBER-LYNN CARMACK

Provider Business Mailing Address
First Line	:	4017 GERMAN POINTER WAY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-3531
Country	:	US
Telephone Number	:	682-352-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	6040 CAMP BOWIE BLVD STE 29
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-5602
Country	:	US
Telephone Number	:	682-352-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2019
Last Update Date	:	09/16/2019

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