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General NPI Number Information
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NPI Number | 1528859865
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Entity Type | Individual
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Provider Name | LAUREN MARIE ONTIVEROS PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 05/15/2025
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 3201 S LOOP 256
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City | PALESTINE
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State | TX
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Zip | 75801-6901
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Country | US
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Telephone | 903-661-7057
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Fax |
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Provider Business Mailing Address
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Address Line | 18038 LOOKOUT VLY
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City | FLINT
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State | TX
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Zip | 75762-9602
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Country | US
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Telephone | 915-309-3382
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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 | 2251N0400X
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Taxonomy Name | Neurology Physical Therapist
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License Number | 1200858
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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 | 1200858
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License Number State | TX
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