1972647667 NPI number — MRS. LAGWYN LOUISE DURDEN M.S., ATC, LAT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972647667 NPI number — MRS. LAGWYN LOUISE DURDEN M.S., ATC, LAT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DURDEN
Provider First Name:
LAGWYN
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., ATC, LAT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSON
Provider Other First Name:
LAGWYN
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S.,LAT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972647667
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4200 LINDO LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROUND ROCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78681-2281
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-238-7361
Provider Business Mailing Address Fax Number:
512-232-5054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 SAN JACINTO BLVD
Provider Second Line Business Practice Location Address:
UNIVERISTY OF TEXAS
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78712-1047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-471-7058
Provider Business Practice Location Address Fax Number:
512-232-5054
Provider Enumeration Date:
02/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  AT1443 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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