MEDICARE: STEPHANIE ROSE CHAVARRIA MASSAGE THERAPIST

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	MT117008
2	225700000X	Massage Therapist	MT117008	TX

General Provider Information

NPI Number	:	1508640939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE ROSE CHAVARRIA MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	3621 MATTOX ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-1307
Country	:	US
Telephone Number	:	915-356-8500
Fax Number	:

Provider Business Practice Location Address
First Line	:	3621 MATTOX ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-1307
Country	:	US
Telephone Number	:	915-356-8500
Fax Number	:

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

Provider Enumeration Date	:	08/24/2023
Last Update Date	:	08/24/2023

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