MEDICARE: JOSE LUIS RIOS 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	MT124126	TX

General Provider Information

NPI Number	:	1487362901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE LUIS RIOS MT

Provider Business Mailing Address
First Line	:	537 W KELLIS ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76115-1322
Country	:	US
Telephone Number	:	817-443-4687
Fax Number	:

Provider Business Practice Location Address
First Line	:	537 W KELLIS ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76115-1322
Country	:	US
Telephone Number	:	817-443-4687
Fax Number	:

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

Provider Enumeration Date	:	11/14/2022
Last Update Date	:	11/14/2022

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Directions to “ JOSE LUIS RIOS MT” Practice Location

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