Provider Demographics
NPI:1750707329
Name:TEXAS MEDICAL MASSAGE
Entity type:Organization
Organization Name:TEXAS MEDICAL MASSAGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:CONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, RN
Authorized Official - Phone:832-318-4619
Mailing Address - Street 1:25411 FRIAR LAKE LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-6098
Mailing Address - Country:US
Mailing Address - Phone:832-318-4619
Mailing Address - Fax:
Practice Address - Street 1:25411 FRIAR LAKE LN
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-6098
Practice Address - Country:US
Practice Address - Phone:832-318-4619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1457774150OtherPECOS, EHR, NPPES