=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952786212
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AESTHETIC AND RECONSTRUCTIVE THERAPEUTICS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2015
-----------------------------------------------------
Last Update Date | 11/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2905 SAN GABRIEL ST STE 100
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78705-3548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-815-0123
-----------------------------------------------------
Fax | 512-763-4546
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1101 W 34TH ST # 304
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78705-1907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-815-0123
-----------------------------------------------------
Fax | 512-861-6206
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CHRISTINE FISHER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 512-815-0123
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2086S0122X
-----------------------------------------------------
Taxonomy Name | Plastic and Reconstructive Surgery Physician
-----------------------------------------------------
License Number | P6546
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------