Provider Demographics
NPI:1558841627
Name:BACK 2 NORMAL MASSAGE PLLC
Entity Type:Organization
Organization Name:BACK 2 NORMAL MASSAGE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:DEANTONIO
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMT115919
Authorized Official - Phone:972-467-4071
Mailing Address - Street 1:956 LONGHORN DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-4446
Mailing Address - Country:US
Mailing Address - Phone:972-467-4071
Mailing Address - Fax:469-969-0098
Practice Address - Street 1:3401 CUSTER RD STE 181
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-7599
Practice Address - Country:US
Practice Address - Phone:833-962-7724
Practice Address - Fax:469-969-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLMT115919225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty