MEDICARE: GILYARD MEDICAL AND ONCOLOGY MASSAGE, INC.

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	163WM1400X	Nurse Massage Therapist (NMT)	MT040302	TX

General Provider Information

NPI Number	:	1912489709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GILYARD MEDICAL AND ONCOLOGY MASSAGE, INC.

Provider Business Mailing Address
First Line	:	7400 BLANCO RD STE 122
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-4361
Country	:	US
Telephone Number	:	210-861-7828
Fax Number	:

Provider Business Practice Location Address
First Line	:	7400 BLANCO RD STE 122
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-4361
Country	:	US
Telephone Number	:	210-861-7828
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KIMBLYN GILYARD
Credential	:	RN
Telephone Number	:	210-861-7828

Provider Enumeration Date	:	08/29/2018
Last Update Date	:	08/29/2018

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