Provider Demographics
NPI:1427513050
Name:LIMBRICK, LAFOLLETTE JR (REPT,CNIM)
Entity type:Individual
Prefix:
First Name:LAFOLLETTE
Middle Name:
Last Name:LIMBRICK
Suffix:JR
Gender:M
Credentials:REPT,CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8833 RIVERWELL CIR W
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-7716
Mailing Address - Country:US
Mailing Address - Phone:281-530-8182
Mailing Address - Fax:
Practice Address - Street 1:8833 RIVERWELL CIR W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-7716
Practice Address - Country:US
Practice Address - Phone:281-530-8182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30072472E0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2472E0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherEEG