Provider Demographics
NPI:1164029815
Name:WEEKS, MYSTIE (LMT)
Entity Type:Individual
Prefix:
First Name:MYSTIE
Middle Name:
Last Name:WEEKS
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 1:1529 COUNTY ROAD 1270
Mailing Address - Street 2:
Mailing Address - City:ALVORD
Mailing Address - State:TX
Mailing Address - Zip Code:76225-7509
Mailing Address - Country:US
Mailing Address - Phone:940-453-1372
Mailing Address - Fax:
Practice Address - Street 1:1529 COUNTY ROAD 1270
Practice Address - Street 2:
Practice Address - City:ALVORD
Practice Address - State:TX
Practice Address - Zip Code:76225-7509
Practice Address - Country:US
Practice Address - Phone:940-453-1372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT121300225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist