MEDICARE: MS. FATIMA SHAARAN PATTERSON 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	MT129314	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MT129314	OTHER	TX	TEXAS DEPARTMENT OF LICENSING AND REGULATION

General Provider Information

NPI Number	:	1821621798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. FATIMA SHAARAN PATTERSON LMT

Provider Business Mailing Address
First Line	:	5350 FOSSIL CREEK BLVD APT 812
Second Line	:
City	:	HALTOM CITY
State	:	TX
Zip	:	76137-6236
Country	:	US
Telephone Number	:	214-240-7232
Fax Number	:

Provider Business Practice Location Address
First Line	:	5208 AIRPORT FWY STE 167
Second Line	:
City	:	HALTOM CITY
State	:	TX
Zip	:	76117-5922
Country	:	US
Telephone Number	:	214-240-7232
Fax Number	:

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

Provider Enumeration Date	:	02/19/2020
Last Update Date	:	07/15/2020

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