Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 1278241 | TX |
NPI | 1013519925 |
---|---|
Provider Name | Mr. Bruce Anthony Lamotte JR. |
First Address | Frisco, TX 75034-6066 |
Second Address | Plano, TX 75024-5608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2020 |
Last Update Date | 15/11/2020 |