Healthcare Provider Details

I. General information

NPI: 1477929073
Provider Name (Legal Business Name): LAURA ALICE YEATTS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2015
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 INTERNATIONAL PKWY STE 430
FLOWER MOUND TX
75022
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 469-312-2585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1264163
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: