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General NPI Number Information
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NPI Number | 1881117471
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Entity Type | Organization
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Legal Business Name | LAKEWAY SPORTS PHYSICAL THERAPY
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Dates
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Enumeration Date | 07/25/2017
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Last Update Date | 08/30/2023
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Provider Practice Location Address
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Address Line | 106 TELLUS ST
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City | LAKEWAY
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State | TX
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Zip | 78734-3829
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Country | US
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Telephone | 512-618-0737
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Fax |
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Provider Business Mailing Address
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Address Line | 106 TELLUS ST
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City | LAKEWAY
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State | TX
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Zip | 78734-3829
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Country | US
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Telephone | 512-618-0737
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. IAIN RUSSELL MACGREGOR
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Credential | PT
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Telephone | 512-840-0444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 1212185
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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 | 1212185
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License Number State | TX
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