Individual
JUDY FAWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T., M.M.P.
Contact information
Practice address
317 RR 620 S, SUITE 100B, LAKEWAY, TX 78734-4748
(512) 619-5525
Mailing address
2803 LARIAT TRL, AUSTIN, TX 78734-2312
(512) 619-5525
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
035168
TX
Other
Enumeration date
10/18/2012
Last updated
10/18/2012
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