Basic Information
Provider Information
NPI: 1003008806
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VALENZANO
FirstName: LAURIE
MiddleName: ANN
NamePrefix: DR.
NameSuffix:  
Credential: D.P.T
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9040 FITZSIMMONS DR
Address2:  
City: JOINT BASE LEWIS MCCHORD
State: WA
PostalCode: 984311000
CountryCode: US
TelephoneNumber: 2539680780
FaxNumber: 2539680780
Practice Location
Address1: 9040 FITZSIMMONS DR
Address2:  
City: JOINT BASE LEWIS MCCHORD
State: WA
PostalCode: 984311000
CountryCode: US
TelephoneNumber: 2539680780
FaxNumber: 2539680780
Other Information
ProviderEnumerationDate: 08/15/2007
LastUpdateDate: 02/26/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
174400000X11160NCN Other Service ProvidersSpecialist 
225100000X40QA01383400NJY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 
225100000XPT009916GAN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

ID Information
IDTypeStateIssuerDescription
42661901SCREHABILITATION AGENCY CERTIFICATIONOTHER
11681901GAREHABILITATION AGENCY CERTIFICATIONOTHER


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