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General NPI Number Information
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NPI Number | 1861879082
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Entity Type | Individual
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Provider Name | LARA PITT PT
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Gender | Female
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Dates
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Enumeration Date | 04/27/2015
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Last Update Date | 12/06/2018
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Provider Practice Location Address
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Address Line | 5855 MILTON ST
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City | DALLAS
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State | TX
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Zip | 75206-4202
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Country | US
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Telephone | 469-310-1700
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Fax | 469-310-1701
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Provider Business Mailing Address
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Address Line | 5100 ELDORADO PKWY # 102-20TR
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City | MCKINNEY
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State | TX
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Zip | 75070-6510
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Country | US
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Telephone | 469-310-5170
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Fax | 469-310-1701
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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 | 1178998
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License Number State | TX
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