Provider Demographics
NPI:1710143920
Name:DURHAM, CAROLYN SUE (MASSAGE THERAPY)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:SUE
Last Name:DURHAM
Suffix:
Gender:F
Credentials:MASSAGE THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:79072-7209
Mailing Address - Country:US
Mailing Address - Phone:806-293-6400
Mailing Address - Fax:808-864-3357
Practice Address - Street 1:109 W 9TH ST
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:TX
Practice Address - Zip Code:79072-7209
Practice Address - Country:US
Practice Address - Phone:806-293-6400
Practice Address - Fax:808-864-3357
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05266173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX05266OtherMASSAGE THERAPY REFLEXOGLIST
TX05266OtherMASSAGE THERAPY