Provider Demographics
NPI:1053857235
Name:HASSERT, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:HASSERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 LIBERTY BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1466
Mailing Address - Country:US
Mailing Address - Phone:843-218-6604
Mailing Address - Fax:
Practice Address - Street 1:30 LIBERTY BLVD STE 140
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-1466
Practice Address - Country:US
Practice Address - Phone:610-458-0611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer