Provider Demographics
NPI:1356583207
Name:SCOTT, MANIKA CHRISTINE (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MS
First Name:MANIKA
Middle Name:CHRISTINE
Last Name:SCOTT
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 1:12662 NEWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-3916
Mailing Address - Country:US
Mailing Address - Phone:832-723-8640
Mailing Address - Fax:
Practice Address - Street 1:6575 WEST LOOP SOUTH
Practice Address - Street 2:580
Practice Address - City:HOUSTON/BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401
Practice Address - Country:US
Practice Address - Phone:832-723-8640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX#MT023832225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist