Individual
PHIMNARA L WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
409A BRADFORD AVE, KEMAH, TX 77565-2371
(832) 429-5556
Mailing address
409A BRADFORD AVE, KEMAH, TX 77565-2371
(832) 429-5556
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT139073
TX
Other
Enumeration date
10/15/2025
Last updated
10/15/2025
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