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General NPI Number Information
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NPI Number | 1669710877
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Entity Type | Organization
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Legal Business Name | LYNNE STILLER
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Dates
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Enumeration Date | 01/22/2013
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Last Update Date | 01/22/2013
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Provider Practice Location Address
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Address Line | 3913 TODD LN SUITE 107
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City | AUSTIN
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State | TX
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Zip | 78744-1000
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Country | US
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Telephone | 512-364-0897
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Fax |
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Provider Business Mailing Address
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Address Line | 3913 TODD LN SUITE 107
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City | AUSTIN
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State | TX
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Zip | 78744-1000
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Country | US
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Telephone | 512-364-0897
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Fax |
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Authorized Official
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Title or Position | OWNER/ MASSAGE THERAPIST
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Name | LYNNE STILLER
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Credential | LMT MTI
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Telephone | 512-364-0897
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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 | MT044149
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License Number State | TX
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