MEDICARE: ESSENTIAL BODY BAR

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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1821625815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESSENTIAL BODY BAR

Provider Business Mailing Address
First Line	:	1622 W ALABAMA ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77006-4102
Country	:	US
Telephone Number	:	832-808-0903
Fax Number	:	832-553-7762

Provider Business Practice Location Address
First Line	:	1622 W ALABAMA ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77006-4102
Country	:	US
Telephone Number	:	832-808-0903
Fax Number	:	832-553-7762

Authorized Official
Title or Position	:	NURSE PRACTITIONER/OWNER
Name	:	LETRICE KAY MASON
Credential	:	NP
Telephone Number	:	817-874-5505

Provider Enumeration Date	:	03/27/2020
Last Update Date	:	06/16/2022

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Directions to “ESSENTIAL BODY BAR ” Practice Location

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