Provider Demographics
NPI:1033311998
Name:EVERETT, LAURIE KATHLEEN (PT)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:KATHLEEN
Last Name:EVERETT
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:PO BOX 1084
Mailing Address - Street 2:
Mailing Address - City:RUNNING SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92382-1084
Mailing Address - Country:US
Mailing Address - Phone:909-337-0844
Mailing Address - Fax:909-337-0045
Practice Address - Street 1:29099 HOSPITAL RD
Practice Address - Street 2:SUITE 106
Practice Address - City:LAKE ARROWHEAD
Practice Address - State:CA
Practice Address - Zip Code:92352-0070
Practice Address - Country:US
Practice Address - Phone:909-337-0844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT13022225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist