Organization
THE MICHANIC SHOP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL GILLESPIE (PHYSICAL THERAPIST)
(915) 412-2734
Entity
Organization
Contact information
Practice address
6428 RUXTON LN, AUSTIN, TX 78749-4126
(915) 412-2734
Mailing address
6104 OLD FREDERICKSBURG RD # 92946, AUSTIN, TX 78749-1216
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
09/03/2021
Last updated
09/03/2021
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