Provider Demographics
NPI:1699586891
Name:FREDENTHAL, ALECIA (LMT)
Entity type:Individual
Prefix:
First Name:ALECIA
Middle Name:
Last Name:FREDENTHAL
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 1:5521 SPRINGDALE RD APT 4302
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-6156
Mailing Address - Country:US
Mailing Address - Phone:737-343-4261
Mailing Address - Fax:
Practice Address - Street 1:13377 POND SPRINGS RD STE 108
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78729-7120
Practice Address - Country:US
Practice Address - Phone:737-343-4261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT122246225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist