Healthcare Provider Details

I. General information

NPI: 1558522219
Provider Name (Legal Business Name): LINDA S LONGORIA PT MA OCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 04/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 FORTVIEW RD STE 109
AUSTIN TX
78704-7657
US

IV. Provider business mailing address

PO BOX 151132
AUSTIN TX
78715-1132
US

V. Phone/Fax

Practice location:
  • Phone: 512-892-5250
  • Fax: 512-892-7183
Mailing address:
  • Phone: 512-892-5250
  • Fax: 512-892-7183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number113902
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number602400000
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: