MEDICARE: KRISTINA J TRICE

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	MT109262	TX

General Provider Information

NPI Number	:	1467096131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA J TRICE

Provider Business Mailing Address
First Line	:	4118 WILLOW SPRINGS DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76001-5111
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5609 SW GREEN OAKS BLVD STE 107
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-1153
Country	:	US
Telephone Number	:	682-219-6127
Fax Number	:

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

Provider Enumeration Date	:	11/05/2019
Last Update Date	:	11/05/2019

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