Individual
AMY BAVOUSETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3721 EXECUTIVE CENTER DR, SUITE 201, AUSTIN, TX 78731-1645
(512) 372-3777
(817) 789-6849
Mailing address
305 NE LOOP 820, BUSINESS TOWER 1; SUITE 200, HURST, TX 76053-7209
(817) 292-8787
(817) 789-6849
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1124436
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149984001
—
TX
05
—
207164901
—
TX
Enumeration date
03/20/2013
Last updated
03/20/2013
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