Provider Demographics
NPI:1972647667
Name:DURDEN, LAGWYN LOUISE (MS, ATC, LAT)
Entity Type:Individual
Prefix:MRS
First Name:LAGWYN
Middle Name:LOUISE
Last Name:DURDEN
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:MISS
Other - First Name:LAGWYN
Other - Middle Name:LOUISE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,LAT
Mailing Address - Street 1:4200 LINDO LOOP
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-2281
Mailing Address - Country:US
Mailing Address - Phone:512-238-7361
Mailing Address - Fax:512-232-5054
Practice Address - Street 1:2100 SAN JACINTO BLVD
Practice Address - Street 2:UNIVERISTY OF TEXAS
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712-1047
Practice Address - Country:US
Practice Address - Phone:512-471-7058
Practice Address - Fax:512-232-5054
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT14432255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer