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General NPI Number Information
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NPI Number | 1912864836
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Entity Type | Individual
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Provider Name | SAMANTHA STONEBACK LAC, LMT
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Gender | Female
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Dates
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Enumeration Date | 01/05/2026
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 3625 MENCHACA RD STE 202
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City | AUSTIN
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State | TX
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Zip | 78704-5912
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Country | US
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Telephone | 541-815-2028
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Fax |
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Provider Business Mailing Address
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Address Line | 130 SHAGBARK TRL
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City | BASTROP
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State | TX
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Zip | 78602-2271
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Country | US
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Telephone | 541-815-2028
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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 | MT135316
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License Number State | TX
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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 | AC02245
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License Number State | TX
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