Healthcare Provider Details

I. General information

NPI: 1568367845
Provider Name (Legal Business Name): SARAH TANNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 S IH 35 STE 209
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:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT146549
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: