Provider Demographics
NPI:1558791137
Name:DAIZE, LYNNE A (LMT)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:A
Last Name:DAIZE
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 1:15401 VENADO DRIVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-1659
Mailing Address - Country:US
Mailing Address - Phone:512-560-2523
Mailing Address - Fax:512-266-3418
Practice Address - Street 1:1007 MOPAC CIRCLE
Practice Address - Street 2:SUITE202
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746
Practice Address - Country:US
Practice Address - Phone:512-560-2523
Practice Address - Fax:512-266-3418
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX001441225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist