Provider Demographics
NPI:1679060602
Name:PURPLE LIGHT TOUCH MASSAGE AND WELLNESS LLC
Entity Type:Organization
Organization Name:PURPLE LIGHT TOUCH MASSAGE AND WELLNESS LLC
Other - Org Name:PLT MASSAGE AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELSO
Authorized Official - Suffix:
Authorized Official - Credentials:LMI
Authorized Official - Phone:817-350-9457
Mailing Address - Street 1:5755 RUFE SNOW DR STE 160
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-6058
Mailing Address - Country:US
Mailing Address - Phone:817-520-2234
Mailing Address - Fax:
Practice Address - Street 1:5757 RUFE SNOW DR STE B
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-6080
Practice Address - Country:US
Practice Address - Phone:817-350-9457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-16
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT117848261Q00000X
261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1174926000.Medicaid