Provider Demographics
NPI:1760699466
Name:BUMPASS, MARIE ELENA (LMT)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:ELENA
Last Name:BUMPASS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7106 NORTHERN LIGHTS ST
Mailing Address - Street 2:LOT 109-12
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-1221
Mailing Address - Country:US
Mailing Address - Phone:210-680-8285
Mailing Address - Fax:
Practice Address - Street 1:4319 MEDICAL DR
Practice Address - Street 2:STE 210A
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3381
Practice Address - Country:US
Practice Address - Phone:210-615-0270
Practice Address - Fax:210-615-0278
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXMT007570225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMT007570OtherMASSAGE THERAPIST