Provider Demographics
NPI:1346972635
Name:WOLFE-SCHACTER, LISA M (LMT, CST)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:WOLFE-SCHACTER
Suffix:
Gender:F
Credentials:LMT, CST
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:WOLFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:511 EVES NECKLACE DR
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-2248
Mailing Address - Country:US
Mailing Address - Phone:248-310-4558
Mailing Address - Fax:
Practice Address - Street 1:2222 WESTERN TRAILS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1601
Practice Address - Country:US
Practice Address - Phone:737-471-9066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT135836225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist