Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 1168506 | TX |
NPI | 1013179555 |
---|---|
Provider Name | Mrs. Lori M Anderson |
First Address | Waco, TX 76708-5852 |
Second Address | Waco, TX 76710-2581 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2008 |
Last Update Date | 31/12/2010 |