Provider Demographics
NPI:1356896146
Name:ALBIN, VICKI
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:ALBIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12840 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1528
Mailing Address - Country:US
Mailing Address - Phone:972-404-3077
Mailing Address - Fax:972-404-1124
Practice Address - Street 1:12840 HILLCREST RD
Practice Address - Street 2:SUITE E104
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1528
Practice Address - Country:US
Practice Address - Phone:972-404-3077
Practice Address - Fax:972-404-1124
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT122235225700000X
CA29929225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist