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General NPI Number Information
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NPI Number | 1922607233
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Entity Type | Organization
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Legal Business Name | AUSTIN LYMPHATIC
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Dates
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Enumeration Date | 10/19/2020
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Last Update Date | 10/19/2020
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Provider Practice Location Address
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Address Line | 5750 BALCONES DR STE 107
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City | AUSTIN
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State | TX
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Zip | 78731-4268
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Country | US
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Telephone | 512-751-8146
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Fax |
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Provider Business Mailing Address
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Address Line | 5750 BALCONES DR STE 107
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City | AUSTIN
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State | TX
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Zip | 78731-4268
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MASSAGE THERAPIST
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Name | JESSICA JOHNSON
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Credential | LMT
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Telephone | 512-751-8146
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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