Provider Demographics
NPI:1093907594
Name:GUILBERT, LAURIN SUZANNE (PTA)
Entity Type:Individual
Prefix:MISS
First Name:LAURIN
Middle Name:SUZANNE
Last Name:GUILBERT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 2ND ST SE
Mailing Address - Street 2:
Mailing Address - City:MAGEE
Mailing Address - State:MS
Mailing Address - Zip Code:39111-3625
Mailing Address - Country:US
Mailing Address - Phone:601-849-9882
Mailing Address - Fax:601-849-9871
Practice Address - Street 1:301 2ND ST SE
Practice Address - Street 2:
Practice Address - City:MAGEE
Practice Address - State:MS
Practice Address - Zip Code:39111-3625
Practice Address - Country:US
Practice Address - Phone:601-849-9882
Practice Address - Fax:601-849-9871
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPTA3948225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant