Provider Demographics
NPI:1851848790
Name:FUSION MASSAGE & BODYWORK
Entity Type:Organization
Organization Name:FUSION MASSAGE & BODYWORK
Other - Org Name:FUSION MED MASSAGE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELIQUE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:832-465-5388
Mailing Address - Street 1:20810 UNION PARK CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-4158
Mailing Address - Country:US
Mailing Address - Phone:832-465-5388
Mailing Address - Fax:
Practice Address - Street 1:21703 KINGSLAND BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2520
Practice Address - Country:US
Practice Address - Phone:832-465-5388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX041066225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty