Healthcare Provider Details

I. General information

NPI: 1083501324
Provider Name (Legal Business Name): SUMMIT WELLNESS - CENTRAL TEXAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 S INTERSTATE 35 STE 235
AUSTIN TX
78704-2600
US

IV. Provider business mailing address

2329 EDENBORN AVE
METAIRIE LA
70001-1815
US

V. Phone/Fax

Practice location:
  • Phone: 512-547-1220
  • Fax: 888-830-8403
Mailing address:
  • Phone: 512-547-1220
  • Fax: 888-830-8403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS GWYN
Title or Position: COO
Credential:
Phone: 210-866-5558