Provider Demographics
NPI:1639946585
Name:BARBOSA, NATHAN (LMT)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:BARBOSA
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 1:831 PHILADELPHIA ST
Mailing Address - Street 2:
Mailing Address - City:FATE
Mailing Address - State:TX
Mailing Address - Zip Code:75189-4062
Mailing Address - Country:US
Mailing Address - Phone:214-663-6681
Mailing Address - Fax:
Practice Address - Street 1:7035 GREENVILLE AVE STE 101
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-5109
Practice Address - Country:US
Practice Address - Phone:972-295-0155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X, 225400000X
TX134304225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
No171400000XOther Service ProvidersHealth & Wellness Coach
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner