Individual
ILA PROCELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
407 8TH ST, MOODY, TX 76557-3849
(832) 689-3513
Mailing address
PO BOX 367, MOODY, TX 76557-0367
(832) 689-3513
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT031858
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MT031858
MASSAGE THERAPIST
TX
Enumeration date
02/05/2018
Last updated
06/16/2018
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