MEDICARE: MS. LINDA S LONGORIA PT MA OCS

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	2251X0800X	Orthopedic Physical Therapist	113902	TX
2	2251X0800X	Orthopedic Physical Therapist	602400000	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	177242900	OTHER	TX	DEPARTMENT OF LABOR
2	83661T	OTHER	TX	BCBS
3	0018DZ	OTHER	TX	BCBS GROUP #

General Provider Information

NPI Number	:	1558522219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LINDA S LONGORIA PT MA OCS

Provider Business Mailing Address
First Line	:	PO BOX 151132
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78715-1132
Country	:	US
Telephone Number	:	512-892-5250
Fax Number	:	512-892-7183

Provider Business Practice Location Address
First Line	:	1825 FORTVIEW RD
Second Line	:	STE 109
City	:	AUSTIN
State	:	TX
Zip	:	78704-7657
Country	:	US
Telephone Number	:	512-892-5250
Fax Number	:	512-892-7183

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

Provider Enumeration Date	:	06/24/2008
Last Update Date	:	04/10/2009

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