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General NPI Number Information
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NPI Number | 1336530187
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Entity Type | Organization
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Legal Business Name | BIRDS NEST ACUPUNCTURE
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Dates
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Enumeration Date | 02/16/2015
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Last Update Date | 02/16/2015
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Provider Practice Location Address
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Address Line | 4101 MEDICAL PKWY SUITE 113
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City | AUSTIN
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State | TX
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Zip | 78756-3734
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Country | US
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Telephone | 512-761-6719
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Fax |
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Provider Business Mailing Address
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Address Line | 4101 MEDICAL PKWY SUITE 113
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City | AUSTIN
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State | TX
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Zip | 78756-3734
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Country | US
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Telephone | 512-761-6719
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | MRS. LEAH SHADWICK
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Credential | L.AC.
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Telephone | 512-761-6719
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC01379
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License Number State | TX
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