MEDICARE: NORMAN WASHINGTON LAIRD PT, DPT

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	225100000X	Physical Therapist	1238330	TX

General Provider Information

NPI Number	:	1053742312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NORMAN WASHINGTON LAIRD PT, DPT

Provider Business Mailing Address
First Line	:	10322 TROTTERS BAY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78254-5927
Country	:	US
Telephone Number	:	210-219-0933
Fax Number	:

Provider Business Practice Location Address
First Line	:	10322 TROTTERS BAY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78254-5927
Country	:	US
Telephone Number	:	210-219-0933
Fax Number	:

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

Provider Enumeration Date	:	12/11/2013
Last Update Date	:	12/11/2013

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