MEDICARE: RIAL MASSAGE

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	104671	TX

General Provider Information

NPI Number	:	1689039786
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIAL MASSAGE

Provider Business Mailing Address
First Line	:	10211 APPLERIDGE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-4706
Country	:	US
Telephone Number	:	832-744-6656
Fax Number	:

Provider Business Practice Location Address
First Line	:	10111 GRANT RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-4534
Country	:	US
Telephone Number	:	832-744-6656
Fax Number	:

Authorized Official
Title or Position	:	LICENSE MASSAGE THERAPIST
Name	:	LILIANA AHUALLI
Credential	:	LMT. PE
Telephone Number	:	832-744-6656

Provider Enumeration Date	:	12/16/2015
Last Update Date	:	12/16/2015

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Directions to “RIAL MASSAGE ” Practice Location

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