Healthcare Provider Details

I. General information

NPI: 1841454253
Provider Name (Legal Business Name): LWM MEDICAL PRACTICE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4447 N CENTRAL EXPY STE. 110, PMB 277
DALLAS TX
75205-4245
US

IV. Provider business mailing address

4447 N CENTRAL EXPY STE. 110, PMB 277
DALLAS TX
75205-4245
US

V. Phone/Fax

Practice location:
  • Phone: 214-684-3695
  • Fax:
Mailing address:
  • Phone: 214-684-3695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberN0294
License Number StateTX

VIII. Authorized Official

Name: LADELLE W. MORSE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 214-684-3695