Provider Demographics
NPI:1063442275
Name:BERTSCHE, LAURIE ANN (MS PT)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:ANN
Last Name:BERTSCHE
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 BARKLEY BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-6696
Mailing Address - Country:US
Mailing Address - Phone:360-733-4008
Mailing Address - Fax:360-733-4064
Practice Address - Street 1:2075 BARKLEY BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-6696
Practice Address - Country:US
Practice Address - Phone:360-733-4008
Practice Address - Fax:360-733-4064
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 00008414225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0210014OtherLABOR & INDUSTRIES
P00322615OtherRAILROAD MEDICARE
WA8339277Medicaid
P56875Medicare UPIN
WAG8860622Medicare PIN