MEDICARE: SUMMIT WELLNESS - CENTRAL TEXAS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1235089699
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT WELLNESS - CENTRAL TEXAS LLC

Provider Business Mailing Address
First Line	:	2329 EDENBORN AVE
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70001-1815
Country	:	US
Telephone Number	:	504-571-5355
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 HERITAGE CENTER CIR
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-4463
Country	:	US
Telephone Number	:	512-547-1220
Fax Number	:	888-830-8403

Authorized Official
Title or Position	:	COO
Name	:	NICK GWYN
Credential	:
Telephone Number	:	504-571-5355

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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