Provider Demographics
NPI:1285908418
Name:TALLENT, LAURA CHRISTINE (LPTA)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:CHRISTINE
Last Name:TALLENT
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S RAY ROBERTS PKWY
Mailing Address - Street 2:
Mailing Address - City:TIOGA
Mailing Address - State:TX
Mailing Address - Zip Code:76271-3527
Mailing Address - Country:US
Mailing Address - Phone:469-951-0270
Mailing Address - Fax:
Practice Address - Street 1:1204 SHERMAN DR
Practice Address - Street 2:
Practice Address - City:WHITESBORO
Practice Address - State:TX
Practice Address - Zip Code:76273
Practice Address - Country:US
Practice Address - Phone:940-564-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 23105225200000X
TX2115823225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant