Provider Demographics
NPI:1669928628
Name:LAUBHAN, LAURA DALE (PT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:DALE
Last Name:LAUBHAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1381 S WEST BAY SHORE DR
Mailing Address - Street 2:
Mailing Address - City:SUTTONS BAY
Mailing Address - State:MI
Mailing Address - Zip Code:49682-9498
Mailing Address - Country:US
Mailing Address - Phone:231-271-0375
Mailing Address - Fax:231-271-0376
Practice Address - Street 1:1381 S WEST BAY SHORE DR
Practice Address - Street 2:
Practice Address - City:SUTTONS BAY
Practice Address - State:MI
Practice Address - Zip Code:49682-9498
Practice Address - Country:US
Practice Address - Phone:231-271-0375
Practice Address - Fax:231-271-0376
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL807802225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist