Provider Demographics
NPI:1346588969
Name:MATA, LAURA (DPT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MATA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11242 FM 1960 RD W STE 104
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-3635
Mailing Address - Country:US
Mailing Address - Phone:814-692-8163
Mailing Address - Fax:281-469-5559
Practice Address - Street 1:11242 FM 1960 RD W STE 104
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-3635
Practice Address - Country:US
Practice Address - Phone:814-692-8163
Practice Address - Fax:281-469-5559
Is Sole Proprietor?:No
Enumeration Date:2013-01-17
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115015225X00000X
TX1227079225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist