Healthcare Provider Details

I. General information

NPI: 1396613014
Provider Name (Legal Business Name): LAX GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2025
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26077 NELSON WAY STE 202
KATY TX
77494-5665
US

IV. Provider business mailing address

3506 BRIGHT MOON CT
KATY TX
77449-1999
US

V. Phone/Fax

Practice location:
  • Phone: 803-318-8458
  • Fax:
Mailing address:
  • Phone: 803-318-8458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: REGINA-CHERON B VAZQUEZ
Title or Position: OWNER
Credential: LMT
Phone: 803-318-8458