Provider Demographics
NPI:1902059298
Name:WELLNESS MATTERS TWO
Entity Type:Organization
Organization Name:WELLNESS MATTERS TWO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CULLEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:TENNISON
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:512-458-6386
Mailing Address - Street 1:3305 NORTHLAND DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4961
Mailing Address - Country:US
Mailing Address - Phone:512-275-0282
Mailing Address - Fax:512-275-0281
Practice Address - Street 1:4105 MEDICAL PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3725
Practice Address - Country:US
Practice Address - Phone:512-458-6386
Practice Address - Fax:512-458-6388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11302501225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty