Provider Demographics
NPI:1861992737
Name:SCOTT, PATRICE I (LMT, BCTMB)
Entity type:Individual
Prefix:
First Name:PATRICE
Middle Name:I
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LMT, BCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TIME2RELAX LLC
Mailing Address - Street 2:2425 TAYLOR ST #11138
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-5949
Mailing Address - Country:US
Mailing Address - Phone:469-978-6548
Mailing Address - Fax:469-978-6548
Practice Address - Street 1:2425 TAYLOR ST APT 11138
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-5949
Practice Address - Country:US
Practice Address - Phone:469-978-6548
Practice Address - Fax:469-978-6548
Is Sole Proprietor?:No
Enumeration Date:2018-02-17
Last Update Date:2018-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT125071225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
511896-06OtherBOARD CERTIFIED IN THERAPEUTIC MASSAGE & BODYWORK
TXMT125071OtherLICENSED MASSAGE THERAPIST