Individual
KEYUNA S CARROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
5035 WILLIS AVE, DALLAS, TX 75206-6406
(469) 658-9116
Mailing address
5035 WILLIS AVE, DALLAS, TX 75206-6406
(469) 658-9116
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
113362
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
113362
TEXAS DEPARTMENT OF STATE HEALTH SERVICES
TX
Enumeration date
12/28/2011
Last updated
12/28/2011
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