Provider Demographics
NPI:1619635240
Name:MOWAT, ANN (LAC)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:MOWAT
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 1:1204 W 22ND 1/2 ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-5304
Mailing Address - Country:US
Mailing Address - Phone:512-762-6521
Mailing Address - Fax:
Practice Address - Street 1:806 W 10TH ST STE A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-2060
Practice Address - Country:US
Practice Address - Phone:512-762-6521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTXAC1030171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist