MEDICARE: PATSY LI PUPO 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	11506	TX

General Provider Information

NPI Number	:	1710541628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATSY LI PUPO MT

Provider Business Mailing Address
First Line	:	16150 KIETH HARROW BLVD APT 3201
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-5468
Country	:	US
Telephone Number	:	281-661-0071
Fax Number	:

Provider Business Practice Location Address
First Line	:	6989 W LITTLE YORK RD STE 25B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77040-4843
Country	:	US
Telephone Number	:	281-661-0071
Fax Number	:

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

Provider Enumeration Date	:	04/25/2019
Last Update Date	:	04/25/2019

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Directions to “ PATSY LI PUPO MT” Practice Location

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