Provider Demographics
NPI:1326299157
Name:KREYDIN, AMY (NBCRT, CCAP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:KREYDIN
Suffix:
Gender:F
Credentials:NBCRT, CCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11673 JOLLYVILLE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4200
Mailing Address - Country:US
Mailing Address - Phone:512-666-9374
Mailing Address - Fax:
Practice Address - Street 1:11673 JOLLYVILLE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4200
Practice Address - Country:US
Practice Address - Phone:512-666-9374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-10
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX173C00000X
MAMAEX612173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist