Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | H2890 | TX |
NPI | 1033217450 |
---|---|
Provider Name | Dr. Lori Beth Wasserburger |
First Address | Austin, TX 78755-2165 |
Second Address | Austin, TX 78746-7874 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 14/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4295756 | AETNA (01) | TX |
80W550 | BCBS (01) | |
E98496 | (02) | TX |
E-98496 | UPIN (01) |