Provider Demographics
NPI:1912282468
Name:MERTZ, LAURA M (MS, LAT, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:MERTZ
Suffix:
Gender:F
Credentials:MS, LAT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11122 QUAIL PASS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3143
Mailing Address - Country:US
Mailing Address - Phone:913-230-0361
Mailing Address - Fax:
Practice Address - Street 1:11122 QUAIL PASS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-3143
Practice Address - Country:US
Practice Address - Phone:913-230-0361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer