Provider Demographics
NPI:1730193947
Name:HOLT EYTING, LAURIE (PT)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:HOLT EYTING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:HOLT
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:326 ALUM CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78957-5072
Mailing Address - Country:US
Mailing Address - Phone:512-470-8337
Mailing Address - Fax:512-237-2458
Practice Address - Street 1:7709 BECKETT RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-2955
Practice Address - Country:US
Practice Address - Phone:512-891-6648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist