Ila Procell, LMT
Individual provider Active NPI Massage Therapist · Moody, TX
NPI 1821597964 · NPPES record last updated Jun 16, 2018
Key facts
- NPI
- 1821597964
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- MT031858 (TX)
- Practice address
- 407 8TH St
Moody, TX 76557-3849 - Phone
- (832) 689-3513
- NPI assigned
- Feb 5, 2018
- 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 |
|---|---|---|---|
| MT031858 | TX | MD | Massage Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MT031858 | TX | Yes |
Addresses
Primary practice location
407 8TH St
Moody, TX 76557-3849
Mailing address
PO Box 367
Moody, TX 76557-0367
Phone (832) 689-3513
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MT031858 | Other | TX | MASSAGE THERAPIST |
Other providers in Moody, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 16, 2018. 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.