Basic Information
| Provider Information | |||||||||
| NPI: | 1528100831 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRATHER | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MSPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1188 106TH AVE NE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980048614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254544864 | ||||||||
| FaxNumber: | 4256463901 | ||||||||
| Practice Location | |||||||||
| Address1: | 1188 106TH AVE NE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980048614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254512630 | ||||||||
| FaxNumber: | 4254514390 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT00003437 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.