MEDICARE: MRS. RITA S. OLUFOWOSHE M.M.P

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	MT104006	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MT104006	OTHER	TX	TEXAS DEPARTMENT OF STATE HEALTH SERVICES

General Provider Information

NPI Number	:	1407184971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RITA S. OLUFOWOSHE M.M.P

Provider Business Mailing Address
First Line	:	5306 SUNDOWN CANYON CT
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-2488
Country	:	US
Telephone Number	:	281-496-3772
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 THREADNEEDLE ST STE 145
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77079-2910
Country	:	US
Telephone Number	:	281-496-3772
Fax Number	:

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

Provider Enumeration Date	:	11/21/2009
Last Update Date	:	09/03/2023

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