Organization Name: | EXQUISITE BODY CLINIC |
NPI Number: | 1780900118 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CLEMMIE SMALLHORNE (OWNER/MANAGER) |
Mailing Address: | 3863 South Fwy Suite 118 Fort Worth |
State: | TX US |
Postal Code: | 761105656 |
Phone Number: | 8179215088 |
Fax Number: | 8179215087 |
NPI Enumeration Date: | 04/09/2010 |
NPI Last Update Date: | 04/14/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | MT002346 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |