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NPI Code Detail

MEDICARE: MS. LAURA ANN WITT

MEDICARE: MS. LAURA ANN WITT
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
1225200000XPhysical Therapy Assistant2037208TX

General Provider Information

NPI Number : 1487136610
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LAURA ANN WITT
Provider Business Mailing Address
First Line : 11305 HUNGRY HORSE DR
Second Line :
City : MANOR
State : TX
Zip : 78653-4656
Country : US
Telephone Number : 512-422-4860
Fax Number :
Provider Business Practice Location Address
First Line : 400 OLD AUSTIN HWY
Second Line :
City : BASTROP
State : TX
Zip : 78602-5168
Country : US
Telephone Number : 512-321-2529
Fax Number : 512-321-6874
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2018
Last Update Date : 09/04/2018

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