Individual
MISTYANNE GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1606 N SYLVANIA AVE, FORT WORTH, TX 76111-2733
(972) 567-0718
Mailing address
232 COOPER DR, HURST, TX 76053-6129
(972) 567-0718
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT133835
TX
Other
Enumeration date
09/01/2020
Last updated
09/01/2020
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