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General NPI Number Information
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NPI Number | 1538508197
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Entity Type | Organization
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Legal Business Name | PEACH WOOD WELLNESS PC
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Dates
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Enumeration Date | 06/17/2013
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Last Update Date | 06/17/2013
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Provider Practice Location Address
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Address Line | 8301 BROADWAY ST SUITE 422
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City | SAN ANTONIO
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State | TX
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Zip | 78209-2006
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Country | US
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Telephone | 210-701-1509
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Fax |
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Provider Business Mailing Address
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Address Line | 642 CROSSPOINT DR
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City | NEW BRAUNFELS
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State | TX
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Zip | 78130-2695
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MATTHEW HANSON
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Credential | L.AC.
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Telephone | 210-701-1509
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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 | AC01331
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License Number State | TX
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