Provider Demographics
NPI:1285909804
Name:PASCHAL, FARON KEITH (MEDICAL MASSAGE THER)
Entity type:Individual
Prefix:
First Name:FARON
Middle Name:KEITH
Last Name:PASCHAL
Suffix:
Gender:M
Credentials:MEDICAL MASSAGE THER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5020 50TH ST UNIT 101
Mailing Address - Street 2:YORKTOWN PLAZA
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414-3422
Mailing Address - Country:US
Mailing Address - Phone:806-548-6061
Mailing Address - Fax:
Practice Address - Street 1:5020 50TH ST UNIT 101
Practice Address - Street 2:YORKTOWN PLAZA
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-3422
Practice Address - Country:US
Practice Address - Phone:806-548-6061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT102936225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist