MEDICARE: KANDI CHAMPION LMT

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	MT041181	TX

General Provider Information

NPI Number	:	1316889447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KANDI CHAMPION LMT

Provider Business Mailing Address
First Line	:	609 BRADFORD AVE
Second Line	:	ST 102A
City	:	KEMAH
State	:	TX
Zip	:	77565
Country	:	US
Telephone Number	:	281-309-1707
Fax Number	:

Provider Business Practice Location Address
First Line	:	609 BRADFORD AVE
Second Line	:	ST 102A
City	:	KEMAH
State	:	TX
Zip	:	77565
Country	:	US
Telephone Number	:	281-309-1707
Fax Number	:

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

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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Directions to “ KANDI CHAMPION LMT” Practice Location

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