Provider Demographics
NPI:1942525472
Name:VILLALBOZ, LISA (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:VILLALBOZ
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 PLANTATION DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-5038
Mailing Address - Country:US
Mailing Address - Phone:832-595-6001
Mailing Address - Fax:832-595-6003
Practice Address - Street 1:815 PLANTATION DR
Practice Address - Street 2:SUITE 160
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-5038
Practice Address - Country:US
Practice Address - Phone:832-595-6001
Practice Address - Fax:832-595-6003
Is Sole Proprietor?:No
Enumeration Date:2010-03-27
Last Update Date:2010-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20-1764594111N00000X
TXMT032837174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No111N00000XChiropractic ProvidersChiropractor