Provider Demographics
NPI:1669874475
Name:CARPENTER, LAURA RUTH (LMP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:RUTH
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16250 NE 80TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3821
Mailing Address - Country:US
Mailing Address - Phone:425-867-1119
Mailing Address - Fax:
Practice Address - Street 1:16250 NE 80TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3821
Practice Address - Country:US
Practice Address - Phone:425-867-1119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2014-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60493329225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist