Provider Demographics
NPI:1073845012
Name:EDMUNDSON, LAURA ANN (MPT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:EDMUNDSON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17300 N OUTER 40 RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-1364
Mailing Address - Country:US
Mailing Address - Phone:636-728-1777
Mailing Address - Fax:636-728-1793
Practice Address - Street 1:17300 N OUTER 40 RD
Practice Address - Street 2:SUITE 202
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1364
Practice Address - Country:US
Practice Address - Phone:636-728-1777
Practice Address - Fax:636-728-1793
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010003418225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist