Provider Demographics
NPI:1346073236
Name:THIRD COAST AESTHETICS AND WELLNESS
Entity type:Organization
Organization Name:THIRD COAST AESTHETICS AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:REEDER
Authorized Official - Suffix:
Authorized Official - Credentials:EMTP
Authorized Official - Phone:409-203-7782
Mailing Address - Street 1:2005 POST OFFICE ST
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-2096
Mailing Address - Country:US
Mailing Address - Phone:409-203-7782
Mailing Address - Fax:
Practice Address - Street 1:2005 POST OFFICE ST
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-2096
Practice Address - Country:US
Practice Address - Phone:409-203-7782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center