Organization
HANNINGTON MASSAGE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES KEZENGWA LMT (CHIEF EXECUTIVE OFFICER)
(817) 405-9540
Entity
Organization
Contact information
Practice address
3212 COLLINSWORTH ST, SUITE 14, FORT WORTH, TX 76107-6580
(817) 405-9540
Mailing address
3212 COLLINSWORTH ST, SUITE 14, FORT WORTH, TX 76107-6580
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
MT2398
TX
Other
Enumeration date
01/15/2014
Last updated
01/15/2014
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