PEACOCK HEAVENLY MASSAGE (NPI# 1003295312) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003295312 |
| Entity Type | Organization |
| Organization Name | PEACOCK HEAVENLY MASSAGE |
| Practice Address |
3800 Hwy 365 Regional Square Port Arthur TX 77642 |
| Mailing Address |
3800 Hwy 365, Suite 159 Port Arthur TX 77642 |
| Practice Telephone | 4097247882 |
| Mailing Telephone | 4097247882 |
| Mailing Fax Number | 4098531777 |
| Enumeration Date | 2015-05-20 |
| Last Update Date | 2015-05-20 |
| Authorized Official Name | MRS. LUCY MAE PEACOCK (LIS. MASSAGE THERAPIST) |
| Authorized Official Telephone | 4097247882 |
| Authorized Official Credential | LMT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 225700000X | Massage Therapist | MT034536 | TX | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
3800 HWY 365 REGIONAL SQUARE |
| City | PORT ARTHUR |
| State | TX |
| Zip Code | 77642 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164038253 | Residential Senior Care (rsc) | Assisted Living Facility | 8040 Honeywood Trial, Port Arthur, TX 77642 | 2020-09-23 |
| 1912547746 | Port Arthur Surgical Center, LLC | Clinic/Center | 3919 Twin City Hwy, Port Arthur, TX 77642 | 2020-01-09 |
| 1538533906 | Carolyn Williams | Nurse Practitioner | 8333 9th Ave Ste A, Port Arthur, TX 77642 | 2015-11-22 |
| 1346651718 | Bunrith Koy | Family Medicine | 3620 East Farm To Market Road 365, Port Arthur, TX 77642 | 2014-05-19 |
| 1679896534 | Jared Clark Mallory | Physical Therapist | 3398 25th Street, Port Arthur, TX 77642 | 2010-03-08 |
| 1750564902 | Isam N. Anabtawi | Family Medicine | 1750 9th Ave., Suite 202, Port Arthur, TX 77642 | 2007-12-11 |
| 1710179445 | Marian Tan Medical Group Ltd LLP | Pediatrics | 3220 Central Mall Drive, Port Arthur, TX 77642 | 2007-08-16 |
| 1497952253 | Waheeda Mithani | Surgery | 3820 Hwy. 365, Suite 200, Port Arthur, TX 77642 | 2007-06-27 |
| 1295939015 | Pamela Spencer Albacete | Speech-Language Pathologist | 7200 9th Ave., Port Arthur, TX 77642 | 2007-06-14 |
| 1295939973 | Chalita La Shon Roberts | Physical Therapy Assistant | 7200 9th Avenue, Port Arthur, TX 77642 | 2007-06-14 |
| Find all providers in zip 77642 | ||||
| Taxonomy Code | 225700000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Massage Therapist |
| An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366774796 | Victoria Akachukwu | Massage Therapist | 3100 Memorial Blvd, Port Arthur, TX 77640-2734 | 2010-02-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083215743 | Stephanie S Bell | Massage Therapist | 5415 Parry Ave, Dallas, TX 75223-1856 | 2020-11-07 |
| 1437750239 | Vincent Trinh | Massage Therapist | 8219 La Roche Ln, Houston, TX 77036-7305 | 2020-11-06 |
| 1295336691 | Emily Burris | Massage Therapist | 1202 Juniper, Princeton, TX 75407-2867 | 2020-11-03 |
| 1790386043 | Julian Denman | Massage Therapist | 4009 Victory Dr Apt C311, Austin, TX 78704-7588 | 2020-11-03 |
| 1154922474 | Shavana Williams | Massage Therapist | 3787 Perrin Central Blvd Apt 927, San Antonio, TX 78217-2822 | 2020-11-03 |
| 1821698960 | Whivolyn Thomas | Massage Therapist | 3939 Synott Rd Apt 402, Houston, TX 77082-5231 | 2020-10-28 |
| 1790385730 | Beatriz Y Ogarek | Massage Therapist | 9945 Barker Cypress Rd Ste 200, Cypress, TX 77433-5319 | 2020-10-28 |
| 1598364002 | Angelique Bella | Massage Therapist | 2832 Rush Creek Rd, Mckinney, TX 75072-7224 | 2020-10-26 |
| 1770182255 | Tyana Washington | Massage Therapist | 1018 Port Neches Dr, Little Elm, TX 75068-5935 | 2020-10-26 |
| 1235738717 | Daniel Peterson | Massage Therapist | 5800 Brodie Ln Apt 216, Austin, TX 78745-2530 | 2020-10-26 |
| Find all providers with the same taxonomy | ||||
| City | PORT ARTHUR |
| Zip Code | 77642 |
Please comment or provide details below to improve the information on PEACOCK HEAVENLY MASSAGE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.