Healthcare Provider Details

I. General information

NPI: 1568656403
Provider Name (Legal Business Name): WELLNESS MATTERS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11009 MAELIN DR
AUSTIN TX
78739-2051
US

IV. Provider business mailing address

11009 MAELIN DR
AUSTIN TX
78739-2051
US

V. Phone/Fax

Practice location:
  • Phone: 512-275-0282
  • Fax: 972-459-3418
Mailing address:
  • Phone: 512-275-0282
  • Fax: 972-459-3418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1130250
License Number StateTX

VIII. Authorized Official

Name: CULLEN F TENNISON
Title or Position: OWNER
Credential: PT
Phone: 512-275-0282