Provider Demographics
NPI:1073230066
Name:HARIAN, KAYLYNN (LMT COS)
Entity Type:Individual
Prefix:
First Name:KAYLYNN
Middle Name:
Last Name:HARIAN
Suffix:
Gender:F
Credentials:LMT COS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8801 N FM 620 RD APT 1227
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78726-3523
Mailing Address - Country:US
Mailing Address - Phone:619-886-2194
Mailing Address - Fax:
Practice Address - Street 1:209 12TH ST STE 211
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-6208
Practice Address - Country:US
Practice Address - Phone:682-214-7452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX129109225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist