Kaylie Long, LMT
Individual provider Active NPI Massage Therapist · Sudan, TX
NPI 1174499487 · NPPES record last updated Oct 14, 2025
Key facts
- NPI
- 1174499487
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- MT139739 (TX)
- Practice address
- 410 E 3Rd Ave
Sudan, TX 79371-2426 - Phone
- (469) 967-0722
- NPI assigned
- Oct 14, 2025
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT139739 | TX | MD | Massage Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist |
225700000X | MT139739 | TX | Yes |
Addresses
Primary practice location
410 E 3Rd Ave
Sudan, TX 79371-2426
Mailing address
410 E 3Rd Ave
Sudan, TX 79371-2426
Other providers in Sudan, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 14, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.