MEDICARE: NATHAN BARBOSA LMT

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	171400000X	Health & Wellness Coach
2	225400000X	Rehabilitation Practitioner
3	225700000X	Massage Therapist	134304	TX

General Provider Information

NPI Number	:	1639946585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN BARBOSA LMT

Provider Business Mailing Address
First Line	:	831 PHILADELPHIA ST
Second Line	:
City	:	FATE
State	:	TX
Zip	:	75189-4062
Country	:	US
Telephone Number	:	214-663-6681
Fax Number	:

Provider Business Practice Location Address
First Line	:	7035 GREENVILLE AVE STE 101
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-5109
Country	:	US
Telephone Number	:	972-295-0155
Fax Number	:

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

Provider Enumeration Date	:	12/11/2023
Last Update Date	:	12/11/2023

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Directions to “ NATHAN BARBOSA LMT” Practice Location

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