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General NPI Number Information
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NPI Number | 1174801096
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Entity Type | Individual
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Provider Name | AUTUMN N MASTERS PT
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Gender | Female
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Dates
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Enumeration Date | 07/26/2011
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Last Update Date | 07/26/2011
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Provider Practice Location Address
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Address Line | 18011 DARRINGTON RD
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City | HORIZON CITY
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State | TX
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Zip | 79928-7352
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Country | US
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Telephone | 915-637-4404
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Fax |
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Provider Business Mailing Address
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Address Line | 18011 DARRINGTON RD
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City | HORIZON CITY
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State | TX
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Zip | 79928-7352
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Country | US
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Telephone | 915-637-4404
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1185228
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 26051
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 11831-024
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 0000008614
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License Number State | TN
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