Provider Demographics
NPI:1457985772
Name:FIX, RICHARD (DME, LMT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:FIX
Suffix:
Gender:M
Credentials:DME, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4748 COUNTY ROAD 1100
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:76050-4080
Mailing Address - Country:US
Mailing Address - Phone:817-487-3696
Mailing Address - Fax:
Practice Address - Street 1:4748 COUNTY ROAD 1100
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:TX
Practice Address - Zip Code:76050-4080
Practice Address - Country:US
Practice Address - Phone:817-487-3696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT131975225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist