Provider Demographics
NPI:1477053981
Name:ALTENDORFER, TARYN JODI (LAC)
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:JODI
Last Name:ALTENDORFER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3014 W WILLIAM CANNON DR APT 1122
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-5151
Mailing Address - Country:US
Mailing Address - Phone:512-968-7773
Mailing Address - Fax:
Practice Address - Street 1:3004 S 1ST ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-6388
Practice Address - Country:US
Practice Address - Phone:512-968-7773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01559171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist