Healthcare Provider Details

I. General information

NPI: 1194680215
Provider Name (Legal Business Name): DEPTHERAPEUTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17106 NORTHAVENS CV
PFLUGERVILLE TX
78660-1843
US

IV. Provider business mailing address

17106 NORTHAVENS CV
PFLUGERVILLE TX
78660-1843
US

V. Phone/Fax

Practice location:
  • Phone: 541-499-2334
  • Fax:
Mailing address:
  • Phone: 541-499-2334
  • 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: MARTIN WYRDING
Title or Position: OWNER
Credential: LMT, MTI
Phone: 541-499-2334