Healthcare Provider Details

I. General information

NPI: 1427967058
Provider Name (Legal Business Name): SUMMIT WELLNESS - CENTRAL TEXAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N GREEN ST STE 218
LONGVIEW TX
75601-7335
US

IV. Provider business mailing address

2329 EDENBORN AVE
METAIRIE LA
70001-1815
US

V. Phone/Fax

Practice location:
  • Phone: 430-341-3050
  • Fax: 430-267-3622
Mailing address:
  • Phone: 430-341-3050
  • Fax: 430-267-3622

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: 504-250-5283