Healthcare Provider Details

I. General information

NPI: 1144497231
Provider Name (Legal Business Name): LAURA ESCHENBURG L.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 SAINT MARKS PL SUITE 120
LA GRANGE TX
78945-1251
US

IV. Provider business mailing address

2 SAINT MARKS PL SUITE 120
LA GRANGE TX
78945-1251
US

V. Phone/Fax

Practice location:
  • Phone: 979-242-2401
  • Fax:
Mailing address:
  • Phone: 979-242-2401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1132470
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: