Provider Demographics
NPI:1033217450
Name:WASSERBURGER, LORI BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:BETH
Last Name:WASSERBURGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 27165
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78755-2165
Mailing Address - Country:US
Mailing Address - Phone:512-358-0500
Mailing Address - Fax:512-358-0520
Practice Address - Street 1:2525 WALLINGWOOD DR
Practice Address - Street 2:BLDG 1, STE 212
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-7874
Practice Address - Country:US
Practice Address - Phone:512-358-0500
Practice Address - Fax:512-358-0520
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2890208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4295756OtherAETNA
80W550OtherBCBS
E-98496OtherUPIN
E-98496OtherUPIN