Individual
MR. JAMAL LARONNE DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT CLT
Contact information
Practice address
2757 E SOUTHLAKE BLVD, SUITE 110, SOUTHLAKE, TX 76092
(682) 688-5534
(682) 688-5549
Mailing address
2173 SOUTHERN PLACE, UNIT A, CARROLLTON, TX 75006
(469) 592-1011
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT139208
TX
Other
Enumeration date
09/26/2024
Last updated
09/26/2024
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