Provider Demographics
NPI:1912949058
Name:GRIFFITH-SMITH, LAURA LYN WATSON
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LYN WATSON
Last Name:GRIFFITH-SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6318 FM 1488 RD
Mailing Address - Street 2:150
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-2763
Mailing Address - Country:US
Mailing Address - Phone:936-273-0808
Mailing Address - Fax:936-273-0860
Practice Address - Street 1:6318 FM 1488 RD
Practice Address - Street 2:150
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-2763
Practice Address - Country:US
Practice Address - Phone:936-273-0808
Practice Address - Fax:936-273-0860
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1150896225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7470479OtherAETNA
TX8839716OtherCIGNA
TX8T1295OtherBCBS
TX7470479OtherAETNA
TX8839716OtherCIGNA