MEDICARE: DR. LORI BETH WASSERBURGER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	H2890	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4295756	OTHER	TX	AETNA
2	80W550	OTHER		BCBS
3	E-98496	OTHER		UPIN

General Provider Information

NPI Number	:	1033217450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORI BETH WASSERBURGER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 27165
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78755-2165
Country	:	US
Telephone Number	:	512-358-0500
Fax Number	:	512-358-0520

Provider Business Practice Location Address
First Line	:	2525 WALLINGWOOD DR
Second Line	:	BLDG 1, STE 212
City	:	AUSTIN
State	:	TX
Zip	:	78746-7874
Country	:	US
Telephone Number	:	512-358-0500
Fax Number	:	512-358-0520

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	12/14/2021

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