MEDICARE: MR. HONG WANG 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	225700000X	Massage Therapist	MT110660	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MT110660	OTHER	TX	LMT

General Provider Information

NPI Number	:	1730813635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HONG WANG LMT

Provider Business Mailing Address
First Line	:	2112 BISSONNET ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-1508
Country	:	US
Telephone Number	:	281-216-9193
Fax Number	:	713-583-3232

Provider Business Practice Location Address
First Line	:	2112 BISSONNET ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-1508
Country	:	US
Telephone Number	:	281-216-9193
Fax Number	:	713-583-3232

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

Provider Enumeration Date	:	07/15/2022
Last Update Date	:	07/15/2022

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Directions to “ MR. HONG WANG LMT” Practice Location

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