Healthcare Provider Details

I. General information

NPI: 1346133253
Provider Name (Legal Business Name): SUMMIT WELLNESS - CENTRAL TEXAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 MEDICAL DR STE 360
SAN ANTONIO TX
78229-5623
US

IV. Provider business mailing address

2329 EDENBORN AVE
METAIRIE LA
70001-1815
US

V. Phone/Fax

Practice location:
  • Phone: 726-256-5360
  • Fax: 888-830-8403
Mailing address:
  • Phone: 281-815-8580
  • Fax: 888-830-8403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NICK GWYN
Title or Position: COO
Credential:
Phone: 504-250-5283