Provider Demographics
NPI:1114325024
Name:GRANBURY MASSAGE AND WELLNESS
Entity Type:Organization
Organization Name:GRANBURY MASSAGE AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:MCGINTY
Authorized Official - Last Name:PIPER
Authorized Official - Suffix:
Authorized Official - Credentials:MMP, LMT
Authorized Official - Phone:817-579-7722
Mailing Address - Street 1:222 S MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-1954
Mailing Address - Country:US
Mailing Address - Phone:818-579-7722
Mailing Address - Fax:817-579-7913
Practice Address - Street 1:222 S MORGAN ST
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-1954
Practice Address - Country:US
Practice Address - Phone:818-579-7722
Practice Address - Fax:817-579-7913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT041008305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service