Healthcare Provider Details

I. General information

NPI: 1093670689
Provider Name (Legal Business Name): YANAKORN KAWSANIT FLEITMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 CREEKSIDE ESTATES DR
WYLIE TX
75098-8152
US

IV. Provider business mailing address

3105 CREEKSIDE ESTATES DR
WYLIE TX
75098-8152
US

V. Phone/Fax

Practice location:
  • Phone: 571-213-5161
  • Fax:
Mailing address:
  • Phone: 571-213-5161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberZF10674
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: