Provider Demographics
NPI:1538970306
Name:FIRES, FINNICK LEE (LMT)
Entity type:Individual
Prefix:
First Name:FINNICK
Middle Name:LEE
Last Name:FIRES
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:LEEHMANN
Other - Middle Name:LEVI
Other - Last Name:HAWKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15907 WINDERMERE DR # 200
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-2546
Mailing Address - Country:US
Mailing Address - Phone:830-730-0163
Mailing Address - Fax:
Practice Address - Street 1:15907 WINDERMERE DR STE 200
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-2546
Practice Address - Country:US
Practice Address - Phone:830-730-0163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT138187225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist