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General NPI Number Information
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NPI Number | 1598834848
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Entity Type | Individual
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Provider Name | LAURA R WILLARD
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Gender | Female
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 08/05/2009
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Provider Practice Location Address
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Address Line | 2931 RIDGE RD STE 115
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City | ROCKWALL
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State | TX
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Zip | 75032-6669
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Country | US
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Telephone | 972-771-4343
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Fax |
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Provider Business Mailing Address
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Address Line | 481 ASHWOOD LN
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City | FAIRVIEW
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State | TX
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Zip | 75069-8547
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Country | US
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Telephone | 972-542-8318
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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 | 1135424
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License Number State | TX
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