Provider Demographics
NPI:1154779155
Name:DFW MEDICAL MASSAGE PLLC
Entity type:Organization
Organization Name:DFW MEDICAL MASSAGE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:TINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMP, MMP, MFR, MAT
Authorized Official - Phone:903-456-5712
Mailing Address - Street 1:105 SAINT MARY ST
Mailing Address - Street 2:300
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-4017
Mailing Address - Country:US
Mailing Address - Phone:903-456-5712
Mailing Address - Fax:
Practice Address - Street 1:105 SAINT MARY ST
Practice Address - Street 2:300
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-4017
Practice Address - Country:US
Practice Address - Phone:903-456-5712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty