Provider Demographics
NPI:1609390517
Name:MASSAGE INNOVATION, LLC
Entity Type:Organization
Organization Name:MASSAGE INNOVATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASSAGE THERAPIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:H. RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-449-5493
Mailing Address - Street 1:4615 SOUTHWEST FWY STE 135
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7106
Mailing Address - Country:US
Mailing Address - Phone:713-449-5493
Mailing Address - Fax:713-662-9103
Practice Address - Street 1:4615 SOUTHWEST FWY STE 135
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7106
Practice Address - Country:US
Practice Address - Phone:713-449-5493
Practice Address - Fax:713-662-9103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT031907225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty