Provider Demographics
NPI:1356177380
Name:AVALOS, JESUS JAVIER (LMT)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:JAVIER
Last Name:AVALOS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10015 LAKE CREEK PKWY APT 715
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-1734
Mailing Address - Country:US
Mailing Address - Phone:512-585-2278
Mailing Address - Fax:
Practice Address - Street 1:10015 LAKE CREEK PKWY APT 715
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78729-1734
Practice Address - Country:US
Practice Address - Phone:512-585-2278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT117562225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist