Provider Demographics
NPI:1013200450
Name:LAU, MAURA (PTA)
Entity Type:Individual
Prefix:
First Name:MAURA
Middle Name:
Last Name:LAU
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 E 33RD AVE
Mailing Address - Street 2:APT 1203
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-3970
Mailing Address - Country:US
Mailing Address - Phone:620-960-4342
Mailing Address - Fax:
Practice Address - Street 1:700 MONTEREY PL
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-2266
Practice Address - Country:US
Practice Address - Phone:620-663-9175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02227225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant