=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578953659
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CINDY SERFASS L.M.T., C.H.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2015
-----------------------------------------------------
Last Update Date | 01/28/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12414 ALDERBROOK DR SUITE 102
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78758-2596
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-838-6103
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12414 ALDERBROOK DR SUITE 102
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78758-2596
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-838-6103
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MT101698
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------