MEDICARE: VALLI LEA MT

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	MT015423	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	015423	OTHER	TX	MT

General Provider Information

NPI Number	:	1326316290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALLI LEA MT

Provider Business Mailing Address
First Line	:	17000 EL CAMINO REAL #305A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058
Country	:	US
Telephone Number	:	281-286-4847
Fax Number	:

Provider Business Practice Location Address
First Line	:	17000 EL CAMINO REAL STE 305A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-2634
Country	:	US
Telephone Number	:	281-286-4847
Fax Number	:

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

Provider Enumeration Date	:	12/07/2011
Last Update Date	:	12/07/2011

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Directions to “ VALLI LEA MT” Practice Location

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