Provider Demographics
NPI:1023131133
Name:HOUSE, LAURIE ELIZABETH (DPT)
Entity type:Individual
Prefix:MISS
First Name:LAURIE
Middle Name:ELIZABETH
Last Name:HOUSE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8951 GROVE SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:HAMMONDSPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14840-9739
Mailing Address - Country:US
Mailing Address - Phone:607-569-3627
Mailing Address - Fax:
Practice Address - Street 1:7571 STATE ROUTE 54
Practice Address - Street 2:REHAB SERVICES DEPT. , IRA DAVENPORT MEMORIAL HOSPITAL
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-9504
Practice Address - Country:US
Practice Address - Phone:607-776-8543
Practice Address - Fax:607-776-8635
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028887-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist