Provider Demographics
NPI:1295905685
Name:POKLUDA, LAURA ELIZABETH (ATC)
Entity type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:ELIZABETH
Last Name:POKLUDA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 JERUSALEM DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-8620
Mailing Address - Country:US
Mailing Address - Phone:512-825-1395
Mailing Address - Fax:
Practice Address - Street 1:1618 JERUSALEM DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-8620
Practice Address - Country:US
Practice Address - Phone:512-825-1395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer