Healthcare Provider Details

I. General information

NPI: 1275880486
Provider Name (Legal Business Name): NICOLE E LAIRD PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2012
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 RIVERWALK DR STE 312
SAN MARCOS TX
78666-6936
US

IV. Provider business mailing address

324 RIVERWALK DR STE 312
SAN MARCOS TX
78666-6936
US

V. Phone/Fax

Practice location:
  • Phone: 512-268-9130
  • Fax: 833-437-4389
Mailing address:
  • Phone: 512-268-9130
  • Fax: 833-437-4389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1218061
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: