Individual
LACI SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5408 WOLF RUN, AUSTIN, TX 78749-1238
(972) 971-3185
Mailing address
5408 WOLF RUN, AUSTIN, TX 78749-1238
(972) 971-3185
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT116105
TX
Other
Enumeration date
10/15/2020
Last updated
10/15/2020
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