Provider Demographics
NPI:1063469054
Name:RAYMOND, LAURA A (PT, CHT)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:A
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:PT, CHT
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:A
Other - Last Name:MCGUIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, CHT
Mailing Address - Street 1:70 N COUNTRY RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2161
Mailing Address - Country:US
Mailing Address - Phone:631-331-3608
Mailing Address - Fax:631-331-2392
Practice Address - Street 1:70 N COUNTRY RD
Practice Address - Street 2:SUITE 103
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2161
Practice Address - Country:US
Practice Address - Phone:631-331-3608
Practice Address - Fax:631-331-2392
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013619225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ4WFH1Medicare PIN
NY022R11OtherBCBS