Basic Information
| Provider Information | |||||||||
| NPI: | 1235452715 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOJICA | ||||||||
| FirstName: | LORRAINE | ||||||||
| MiddleName: | WALLIS | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 712 LYNDSIE DR | ||||||||
| Address2: | |||||||||
| City: | COPPELL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750196628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723159422 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8000 FRANKFORD RD | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752526834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722328096 | ||||||||
| FaxNumber: | 9722328099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2010 | ||||||||
| LastUpdateDate: | 03/11/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1046126 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.