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General NPI Number Information
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NPI Number | 1457006272
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Entity Type | Individual
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Provider Name | JASON BRAZIL LMT
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Gender | Male
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Dates
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Enumeration Date | 02/21/2022
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Last Update Date | 02/21/2022
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Provider Practice Location Address
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Address Line | 400 S C M ALLEN PKWY
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City | SAN MARCOS
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State | TX
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Zip | 78666-6904
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Country | US
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Telephone | 512-644-4547
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Fax |
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Provider Business Mailing Address
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Address Line | 1606 HAMILTON ST
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City | SAN MARCOS
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State | TX
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Zip | 78666-2359
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Country | US
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Telephone | 512-644-4547
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 129979
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License Number State | TX
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