Healthcare Provider Details

I. General information

NPI: 1063629723
Provider Name (Legal Business Name): JOANN ESCKILSEN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4319 MEDICAL DR STE 210A
SAN ANTONIO TX
78229-3381
US

IV. Provider business mailing address

PO BOX 26 14515 SHEPHERD
ATASCOSA TX
78002-0026
US

V. Phone/Fax

Practice location:
  • Phone: 210-722-4365
  • Fax: 210-615-0278
Mailing address:
  • Phone: 210-722-4365
  • Fax: 210-615-0278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT002582
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: