Provider Demographics
NPI:1003281676
Name:SOBOTIK, LAUREN RENEE (PTA)
Entity Type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:RENEE
Last Name:SOBOTIK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7801 N LAMAR BLVD STE A114
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-1049
Mailing Address - Country:US
Mailing Address - Phone:512-646-4673
Mailing Address - Fax:512-729-0320
Practice Address - Street 1:7801 N LAMAR BLVD STE A114
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-1049
Practice Address - Country:US
Practice Address - Phone:512-646-4673
Practice Address - Fax:512-729-0320
Is Sole Proprietor?:No
Enumeration Date:2015-12-08
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2106715225200000X
CA48421225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant