Organization
A HEALTHY MASSAGE BY MODESTA
Active
Organization
A HEALTHY MASSAGE BY MODESTA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MODESTA VAN DEN BOGAARD LMT (LICENSED MASSAGE THERAPIST)
(915) 588-2167
Entity
Organization
Contact information
Practice address
9047 POLARIS ST, EL PASO, TX 79904-1122
(915) 588-2167
Mailing address
9047 POLARIS ST, EL PASO, TX 79904-1122
(915) 588-2167
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
101448
TX
Other
Enumeration date
06/27/2014
Last updated
06/27/2014
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