Provider Demographics
NPI:1063843357
Name:BRYCE, TYMOTHY OREN (LAC)
Entity Type:Individual
Prefix:MR
First Name:TYMOTHY
Middle Name:OREN
Last Name:BRYCE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 WESTGATE BLVD
Mailing Address - Street 2:STE. 132-375
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-9997
Mailing Address - Country:US
Mailing Address - Phone:800-977-0959
Mailing Address - Fax:
Practice Address - Street 1:800 W HIGHWAY 290
Practice Address - Street 2:BUILDING F, SUITE 400
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-4191
Practice Address - Country:US
Practice Address - Phone:512-686-0876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-11
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01485171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist