Provider Demographics
NPI:1053082255
Name:NIMTZ, LAURA L (PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:NIMTZ
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 1:3821 WACHTEL DR
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-9783
Mailing Address - Country:US
Mailing Address - Phone:517-331-0162
Mailing Address - Fax:
Practice Address - Street 1:3821 WACHTEL DR
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-9783
Practice Address - Country:US
Practice Address - Phone:517-331-0162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501008086225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist