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General NPI Number Information
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NPI Number | 1427967058
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Entity Type | Organization
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Legal Business Name | SUMMIT WELLNESS - CENTRAL TEXAS LLC
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Dates
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Enumeration Date | 09/01/2026
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Last Update Date | 09/01/2026
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Provider Practice Location Address
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Address Line | 300 N GREEN ST STE 218
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City | LONGVIEW
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State | TX
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Zip | 75601-7335
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Country | US
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Telephone | 430-341-3050
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Fax | 430-267-3622
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Provider Business Mailing Address
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Address Line | 2329 EDENBORN AVE
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City | METAIRIE
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State | LA
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Zip | 70001-1815
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Country | US
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Telephone | 430-341-3050
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Fax | 430-267-3622
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Authorized Official
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Title or Position | COO
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Name | NICHOLAS GWYN
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Credential |
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Telephone | 504-571-5355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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