Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT106959 | TX |
NPI | 1013221928 |
---|---|
Provider Name | Mrs. Lou Ellen Demott |
First Address | Burleson, TX 76028-6120 |
Second Address | Burleson, TX 76028-4227 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2010 |
Last Update Date | 03/08/2010 |