Provider Demographics
NPI:1083698070
Name:BANNISTER, LAURA (DPT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BANNISTER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:JO
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1612 NE 75TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-4372
Mailing Address - Country:US
Mailing Address - Phone:206-854-1809
Mailing Address - Fax:206-260-4565
Practice Address - Street 1:2612 3RD AVENUE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121
Practice Address - Country:US
Practice Address - Phone:206-686-4073
Practice Address - Fax:206-260-4565
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009881225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist