Individual
SHAOYU WAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1504 SMILAX AVE, FORT WORTH, TX 76111-1428
(682) 429-3480
Mailing address
1504 SMILAX AVE, FORT WORTH, TX 76111-1428
(682) 429-3480
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT124699
TX
Other
Enumeration date
12/25/2020
Last updated
12/25/2020
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