Provider Demographics
NPI:1720365042
Name:EDWARDS, JOSANIE L (BS, LMT, LAC)
Entity Type:Individual
Prefix:
First Name:JOSANIE
Middle Name:L
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:BS, LMT, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 S A W GRIMES BLVD
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-7429
Mailing Address - Country:US
Mailing Address - Phone:512-310-7665
Mailing Address - Fax:
Practice Address - Street 1:1250 S A W GRIMES BLVD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-7429
Practice Address - Country:US
Practice Address - Phone:512-310-7665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX01240171100000X
TX111716225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist