Healthcare Provider Details

I. General information

NPI: 1013519925
Provider Name (Legal Business Name): BRUCE ANTHONY LAMOTTE JR. PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2020
Last Update Date: 11/15/2020
Certification Date: 11/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5765 BOZEMAN DR APT 1205
PLANO TX
75024-5608
US

IV. Provider business mailing address

2990 LEGACY DR
FRISCO TX
75034-6066
US

V. Phone/Fax

Practice location:
  • Phone: 817-223-4501
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number1278241
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: