Provider Demographics
NPI:1003050964
Name:TEHENNEPE, LAURA K (BA, LMT)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:K
Last Name:TEHENNEPE
Suffix:
Gender:F
Credentials:BA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 NE 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-5552
Mailing Address - Country:US
Mailing Address - Phone:267-975-6586
Mailing Address - Fax:
Practice Address - Street 1:810 NE 4TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-5552
Practice Address - Country:US
Practice Address - Phone:267-975-6586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA52081225700000X
MEMT711225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist