Healthcare Provider Details

I. General information

NPI: 1518858422
Provider Name (Legal Business Name): SUMMIT WELLNESS - TEMPLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2027 S 61ST ST STE 125
TEMPLE TX
76504-6817
US

IV. Provider business mailing address

2329 EDENBORN AVE
METAIRIE LA
70001-1815
US

V. Phone/Fax

Practice location:
  • Phone: 210-866-5558
  • Fax:
Mailing address:
  • Phone: 504-571-5355
  • 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: NICHOLAS GWYN
Title or Position: COO
Credential:
Phone: 281-815-8580