Provider Demographics
NPI:1861879082
Name:PITT, LARA (PT)
Entity type:Individual
Prefix:MRS
First Name:LARA
Middle Name:
Last Name:PITT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5100 ELDORADO PKWY # 102-20TR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-6510
Mailing Address - Country:US
Mailing Address - Phone:469-310-5170
Mailing Address - Fax:469-310-1701
Practice Address - Street 1:5855 MILTON ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-4202
Practice Address - Country:US
Practice Address - Phone:469-310-1700
Practice Address - Fax:469-310-1701
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-27
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1178998225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist