Provider Demographics
NPI:1215174719
Name:ALBERT, LAURIE TRESE (PT)
Entity type:Individual
Prefix:MISS
First Name:LAURIE
Middle Name:TRESE
Last Name:ALBERT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:LAURIE
Other - Middle Name:TRESE
Other - Last Name:ALBERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:2700 BEE CAVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746
Mailing Address - Country:US
Mailing Address - Phone:512-284-8966
Mailing Address - Fax:
Practice Address - Street 1:2700 BEE CAVE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5675
Practice Address - Country:US
Practice Address - Phone:512-284-8964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1142743174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1142743OtherPHYSICAL THERAPY