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General NPI Number Information
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NPI Number | 1588386684
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Entity Type | Organization
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Legal Business Name | SPORTS MEDICINE ACUPUNCTURE AND TUINA PLLC
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Dates
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Enumeration Date | 09/15/2022
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Last Update Date | 01/05/2024
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Provider Practice Location Address
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Address Line | 6618 SITIO DEL RIO BLVD STE D103
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City | AUSTIN
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State | TX
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Zip | 78730-1148
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Country | US
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Telephone | 833-503-4440
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Fax |
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Provider Business Mailing Address
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Address Line | 10815 RANCH ROAD 2222 STE 3C
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City | AUSTIN
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State | TX
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Zip | 78730-1160
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Country | US
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Telephone | 833-503-4440
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | BRYN KANUCK
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Credential | ACUPUNCTURE
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Telephone | 610-703-8105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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