Provider Demographics
NPI:1679592356
Name:SCHWANZ, LORI (MSPT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:SCHWANZ
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 BEE CAVES ROAD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5676
Mailing Address - Country:US
Mailing Address - Phone:512-732-2220
Mailing Address - Fax:512-732-2227
Practice Address - Street 1:2712 BEE CAVES ROAD
Practice Address - Street 2:SUITE 110
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5676
Practice Address - Country:US
Practice Address - Phone:512-732-2220
Practice Address - Fax:512-732-2227
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1124659225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX650552OtherBLUE CROSS
TX650552Medicare ID - Type Unspecified