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General NPI Number Information
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NPI Number | 1861805103
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Entity Type | Organization
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Legal Business Name | HEALING FOUNDATIONS PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 06/04/2014
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Last Update Date | 06/04/2014
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Provider Practice Location Address
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Address Line | 6810 PONCHA PASS
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City | AUSTIN
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State | TX
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Zip | 78749-4370
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Country | US
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Telephone | 512-814-6526
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Fax | 512-265-2148
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Provider Business Mailing Address
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Address Line | 6810 PONCHA PASS
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City | AUSTIN
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State | TX
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Zip | 78749
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Country | US
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Telephone | 512-814-6526
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Fax | 512-265-2148
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Authorized Official
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Title or Position | OWNER
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Name | CARRIE ANN CIAVERELLI
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Credential | PT
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Telephone | 512-814-6526
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1149167
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License Number State | TX
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