MEDICARE: NAN LI

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	MT132464	TX

General Provider Information

NPI Number	:	1417764291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAN LI

Provider Business Mailing Address
First Line	:	13812 N US HIGHWAY 183 STE B4
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78750-1238
Country	:	US
Telephone Number	:	512-740-6359
Fax Number	:

Provider Business Practice Location Address
First Line	:	13812 N US HIGHWAY 183 STE B4
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78750-1238
Country	:	US
Telephone Number	:	512-740-6359
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2024
Last Update Date	:	12/17/2024

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Directions to “ NAN LI ” Practice Location

Language	Start Address	Practice Location

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