Provider Demographics
NPI:1164790903
Name:EDMONSON, JANE DUNN (LMT)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:DUNN
Last Name:EDMONSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 PLACID CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-1194
Mailing Address - Country:US
Mailing Address - Phone:225-773-0222
Mailing Address - Fax:
Practice Address - Street 1:2100 E STAN SCHLUETER LOOP
Practice Address - Street 2:SUITE 1
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-3807
Practice Address - Country:US
Practice Address - Phone:254-781-0105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT101825225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist