Provider Demographics
NPI:1508230970
Name:ONE, MAJESTIC (LMT)
Entity Type:Individual
Prefix:
First Name:MAJESTIC
Middle Name:
Last Name:ONE
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 1:8207 CANOGA AVE # G3
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78724-5728
Mailing Address - Country:US
Mailing Address - Phone:512-766-6301
Mailing Address - Fax:
Practice Address - Street 1:8207 CANOGA AVE # G3
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78724-5728
Practice Address - Country:US
Practice Address - Phone:512-766-6301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-22
Last Update Date:2015-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120323225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner