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General NPI Number Information
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NPI Number | 1952682197
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Entity Type | Individual
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Provider Name | AVERY WHITE LMT
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Gender | Male
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Dates
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Enumeration Date | 09/01/2011
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Last Update Date | 05/15/2015
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Provider Practice Location Address
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Address Line | 811 W SAINT JOHNS AVE UNIT 2105
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City | AUSTIN
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State | TX
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Zip | 78752-2387
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Country | US
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Telephone | 512-850-7148
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 203894
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City | AUSTIN
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State | TX
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Zip | 78720-3894
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Country | US
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Telephone | 512-850-7148
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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 | MT104847
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License Number State | TX
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