MEDICARE: JITRADA YONGYUEN 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

General Provider Information

NPI Number	:	1962127548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JITRADA YONGYUEN LMT

Provider Business Mailing Address
First Line	:	8403 EMERALD VALLEY CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-5608
Country	:	US
Telephone Number	:	240-596-4975
Fax Number	:

Provider Business Practice Location Address
First Line	:	8403 EMERALD VALLEY CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-5608
Country	:	US
Telephone Number	:	240-596-4975
Fax Number	:

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

Provider Enumeration Date	:	10/06/2022
Last Update Date	:	10/06/2022

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Directions to “ JITRADA YONGYUEN LMT” Practice Location

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