Individual
MRS. MARIE C VERVIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MASSAE THERAPIST
Contact information
Practice address
2125 W SOUTHLAKE BLVD, SOUTHLAKE, TX 76092-6758
(817) 903-4749
Mailing address
821 JOCKEY CLUB LN, FORT WORTH, TX 76179-2359
(817) 847-5694
Taxonomy
Speciality
Code
Description
License number
State
173C00000X
Reflexologist
Primary
MT047765
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
80/0566438
MASSAGE THERAPIST
TX
Enumeration date
11/18/2013
Last updated
11/18/2013
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