Provider Demographics
NPI:1841681541
Name:MATYUS, MARNI (LMT)
Entity type:Individual
Prefix:
First Name:MARNI
Middle Name:
Last Name:MATYUS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6220 CAMPBELL RD STE 203
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1466
Mailing Address - Country:US
Mailing Address - Phone:972-672-4914
Mailing Address - Fax:
Practice Address - Street 1:6220 CAMPBELL RD STE 203
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1466
Practice Address - Country:US
Practice Address - Phone:972-672-4914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112070225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist