Basic Information
| Provider Information | |||||||||
| NPI: | 1619161064 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SKAR | ||||||||
| FirstName: | JOSEPHINE | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5215 HOLLISTER ST | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770406205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134623194 | ||||||||
| FaxNumber: | 7134627502 | ||||||||
| Practice Location | |||||||||
| Address1: | 5215 HOLLISTER ST | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770406205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134623194 | ||||||||
| FaxNumber: | 7134627502 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2007 | ||||||||
| LastUpdateDate: | 08/29/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | MT015659 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.