Provider Demographics
NPI:1275123713
Name:ULRICH, KEVIN (LVN, LMT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:ULRICH
Suffix:
Gender:M
Credentials:LVN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 90683
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78709-0683
Mailing Address - Country:US
Mailing Address - Phone:512-820-0310
Mailing Address - Fax:
Practice Address - Street 1:1202 NEWNING AVE APT 310
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-1857
Practice Address - Country:US
Practice Address - Phone:512-820-0310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT127184225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist