Provider Demographics
NPI:1639884141
Name:SPEIR, ETHAN SAMUEL (LPTA)
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:SAMUEL
Last Name:SPEIR
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4507 TOPACIO DR
Mailing Address - Street 2:
Mailing Address - City:SPICEWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78669-6997
Mailing Address - Country:US
Mailing Address - Phone:601-319-8643
Mailing Address - Fax:
Practice Address - Street 1:1917 LOHMANS CROSSING RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78734-5269
Practice Address - Country:US
Practice Address - Phone:512-261-3211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2174178225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant