Provider Demographics
NPI:1053951053
Name:LAIRD, ELIZABETH O (ATC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:O
Last Name:LAIRD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3729 SUN COUNTRY DR
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-3913
Mailing Address - Country:US
Mailing Address - Phone:513-315-3928
Mailing Address - Fax:
Practice Address - Street 1:4550 US HIGHWAY 281
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-4020
Practice Address - Country:US
Practice Address - Phone:956-574-5671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT48042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAT4804OtherATHLETIC TRAINING LICENSE
060802037OtherBOARD OF CERTIFICATION