Provider Demographics
NPI:1407501620
Name:RAMOS, CHRISTIAN ANTHONY (LMT)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:ANTHONY
Last Name:RAMOS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 LORRAINE AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-4116
Mailing Address - Country:US
Mailing Address - Phone:469-834-1214
Mailing Address - Fax:
Practice Address - Street 1:304 N DOOLEY ST
Practice Address - Street 2:300
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-7605
Practice Address - Country:US
Practice Address - Phone:817-251-9790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT133928225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist