Healthcare Provider Details

I. General information

NPI: 1881058493
Provider Name (Legal Business Name): RAYMOND MATTHEW CAUSA LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2016
Last Update Date: 04/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 SPEIDEL DR
PFLUGERVILLE TX
78660-5267
US

IV. Provider business mailing address

2401 SPEIDEL DR
PFLUGERVILLE TX
78660-5267
US

V. Phone/Fax

Practice location:
  • Phone: 512-923-9365
  • Fax:
Mailing address:
  • Phone: 512-923-9365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT124399
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: