Individual
KEVIN EDGERRON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
6011 BROADWAY ST, SAN ANTONIO, TX 78209-4554
(210) 879-8679
Mailing address
3227 LILLY FLOWER, SAN ANTONIO, TX 78253-6098
(719) 246-0031
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT130062
TX
Other
Enumeration date
03/30/2019
Last updated
03/30/2019
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