Individual
LAURA ELENA BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1420 SHOREVIEW CV, AUSTIN, TX 78732-2233
(512) 299-4626
Mailing address
1420 SHOREVIEW CV, AUSTIN, TX 78732-2233
(512) 299-4626
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
1168830
TX
Other
Enumeration date
04/13/2015
Last updated
04/13/2015
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