Provider Demographics
NPI:1053863274
Name:ABREGO, DOLIA YVETTE (LMT)
Entity Type:Individual
Prefix:
First Name:DOLIA
Middle Name:YVETTE
Last Name:ABREGO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3321
Mailing Address - Country:US
Mailing Address - Phone:956-792-2304
Mailing Address - Fax:
Practice Address - Street 1:250 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3321
Practice Address - Country:US
Practice Address - Phone:956-792-2304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-04
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT107504225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist