Provider Demographics
NPI:1568875706
Name:BIEGON, VALERIE FREEMAN (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:FREEMAN
Last Name:BIEGON
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:MS
Other - First Name:VALERIE
Other - Middle Name:FREEMAN
Other - Last Name:BIEGON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:2702 NW 19TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76106-5019
Mailing Address - Country:US
Mailing Address - Phone:682-201-5330
Mailing Address - Fax:817-624-2780
Practice Address - Street 1:A LA MOD SALON/ VFB-LMT
Practice Address - Street 2:3900 MERRETT DRIVE SUITE B
Practice Address - City:LAKE WORTH
Practice Address - State:TX
Practice Address - Zip Code:76106
Practice Address - Country:US
Practice Address - Phone:682-201-5330
Practice Address - Fax:817-624-2780
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-05
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT114854171W00000X, 225700000X
TX171W00000X171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMT114854OtherMASSAGE LICENSE NUMBER WITH THE STATE