Provider Demographics
NPI:1720587538
Name:SOL MEDICAL MASSAGE INC
Entity Type:Organization
Organization Name:SOL MEDICAL MASSAGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE PRACTICIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED MASSAGE
Authorized Official - Phone:469-701-1097
Mailing Address - Street 1:PO BOX 118381
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75011-8381
Mailing Address - Country:US
Mailing Address - Phone:469-701-1097
Mailing Address - Fax:
Practice Address - Street 1:4666 MCDERMOTT RD SUITE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024
Practice Address - Country:US
Practice Address - Phone:972-668-6868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-07
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT102405225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102405OtherMASSAGE LICENSE