Provider Demographics
NPI:1629804893
Name:THE LAB SPORTS THERAPY AND PERFORMANCE
Entity type:Organization
Organization Name:THE LAB SPORTS THERAPY AND PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:READ
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:WOOLWINE
Authorized Official - Suffix:
Authorized Official - Credentials:MASSAGE THERAPIST
Authorized Official - Phone:512-507-9073
Mailing Address - Street 1:6611 RIVER PLACE BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730-1162
Mailing Address - Country:US
Mailing Address - Phone:512-507-9073
Mailing Address - Fax:
Practice Address - Street 1:6611 RIVER PLACE BLVD STE 104
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78730-1162
Practice Address - Country:US
Practice Address - Phone:512-507-9073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty