MEDICARE: SUMMIT WELLNESS - TEMPLE 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	:	1518858422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT WELLNESS - TEMPLE 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	:	5709 W ADAMS AVE RM 4
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76502-6292
Country	:	US
Telephone Number	:	512-547-1220
Fax Number	:	888-830-8403

Authorized Official
Title or Position	:	COO
Name	:	NICHOLAS GWYN
Credential	:
Telephone Number	:	281-815-8580

Provider Enumeration Date	:	07/10/2025
Last Update Date	:	03/19/2026

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Directions to “SUMMIT WELLNESS - TEMPLE LLC ” Practice Location

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