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General NPI Number Information
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NPI Number | 1558508796
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Entity Type | Individual
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Provider Name | LESLIE ANN RICHARDSON L.M.T.
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Gender | Female
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Dates
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Enumeration Date | 01/09/2009
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Last Update Date | 01/09/2009
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Provider Practice Location Address
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Address Line | 7101 WANDERING OAK RD
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City | AUSTIN
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State | TX
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Zip | 78749-1892
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Country | US
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Telephone | 512-796-6399
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Fax |
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Provider Business Mailing Address
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Address Line | 4970 W HIGHWAY 290 SUITE 480
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City | AUSTIN
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State | TX
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Zip | 78735-6748
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Country | US
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Telephone | 512-796-6399
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT028405
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License Number State | TX
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