MEDICARE: PURPLE LIGHT TOUCH MASSAGE AND WELLNESS LLC

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	261Q00000X	Clinic/Center	MT117848	TX
2	261QP3300X	Pain Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679060602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURPLE LIGHT TOUCH MASSAGE AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	5755 RUFE SNOW DR STE 160
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-6058
Country	:	US
Telephone Number	:	817-520-2234
Fax Number	:

Provider Business Practice Location Address
First Line	:	5757 RUFE SNOW DR STE B
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-6080
Country	:	US
Telephone Number	:	817-350-9457
Fax Number	:

Authorized Official
Title or Position	:	CEO FOUNDER
Name	:	MS. VALERIE KELSO
Credential	:	LMI
Telephone Number	:	817-350-9457

Provider Enumeration Date	:	04/16/2018
Last Update Date	:	03/12/2021

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