MEDICARE: WESTLAKE MEDICAL

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	MT015175	TX

General Provider Information

NPI Number	:	1386890226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTLAKE MEDICAL

Provider Business Mailing Address
First Line	:	101 BLUE RIDGE TRL APT A
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-5404
Country	:	US
Telephone Number	:	512-431-0458
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 BLUE RIDGE TRL APT A
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-5404
Country	:	US
Telephone Number	:	512-431-0458
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KIM TEMPLE
Credential	:	MT
Telephone Number	:	512-431-0458

Provider Enumeration Date	:	08/12/2008
Last Update Date	:	08/12/2008

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Directions to “WESTLAKE MEDICAL ” Practice Location

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