Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | TX | |
N | 2251S0007X | Physical Therapist - Sports | TX | |
N | 2251X0800X | Physical Therapist - Orthopedic | TX |
NPI | 1194163816 |
---|---|
Provider Name | Alicia Dean Shugart |
First Address | Round Rock, TX 78681-8018 |
Second Address | Round Rock, TX 78681-8018 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2013 |
Last Update Date | 05/06/2013 |