Individual
JOHNNY KHAMPHOUSENG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
11100 MONICA CT, FORT WORTH, TX 76244-7434
(682) 247-6075
Mailing address
11100 MONICA CT, FORT WORTH, TX 76244-7434
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
10/21/2020
Last updated
10/21/2020
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