MEDICARE: PREMPORN HEMAN

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	MT115989	TX

General Provider Information

NPI Number	:	1366845497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PREMPORN HEMAN

Provider Business Mailing Address
First Line	:	1305B WAUGH DR.
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1305B WAUGH DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77019-3907
Country	:	US
Telephone Number	:	832-581-1686
Fax Number	:

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

Provider Enumeration Date	:	10/03/2014
Last Update Date	:	10/03/2014

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Directions to “ PREMPORN HEMAN ” Practice Location

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