Individual
MR. BENNY RAY GUSTAFSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.M.T.
Contact information
Practice address
123 TOPEKA DR, SUITE H, WOODWAY, TX 76712-6168
(254) 723-1811
Mailing address
328 WILL BOLEMAN DR, HEWITT, TX 76643-3601
(254) 666-5334
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT042353
TX
Other
Enumeration date
02/08/2007
Last updated
07/08/2007
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