Provider Demographics
NPI:1295577047
Name:FAITHFUL MODALITIES MEDICAL MASSAGE LLC
Entity type:Organization
Organization Name:FAITHFUL MODALITIES MEDICAL MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEAVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALER-MACIAS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:361-502-1793
Mailing Address - Street 1:PO BOX 1246
Mailing Address - Street 2:
Mailing Address - City:INGLESIDE
Mailing Address - State:TX
Mailing Address - Zip Code:78362-1246
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2761 W MAIN ST STE 9
Practice Address - Street 2:
Practice Address - City:INGLESIDE
Practice Address - State:TX
Practice Address - Zip Code:78362-5751
Practice Address - Country:US
Practice Address - Phone:361-502-1793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-12
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty