Provider Demographics
NPI:1093761736
Name:DUREL, LAURA CAMILLE (MSPT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:CAMILLE
Last Name:DUREL
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 GUNBARREL RD
Mailing Address - Street 2:STE 408
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2663
Mailing Address - Country:US
Mailing Address - Phone:423-508-4461
Mailing Address - Fax:
Practice Address - Street 1:1608 GUNBARREL RD STE 103
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7244
Practice Address - Country:US
Practice Address - Phone:423-892-8070
Practice Address - Fax:423-893-9891
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4105829OtherBCBST
TN5441657Medicaid
TN3645657Medicaid
TN3645657Medicaid
TN3650060Medicare PIN