Provider Demographics
NPI:1104844265
Name:VANNUCCI, LAURA NAKATA (MPT)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:NAKATA
Last Name:VANNUCCI
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 1:840 SE BISHOP BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5502
Mailing Address - Country:US
Mailing Address - Phone:509-338-9204
Mailing Address - Fax:509-338-9206
Practice Address - Street 1:840 SE BISHOP BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5502
Practice Address - Country:US
Practice Address - Phone:509-338-9204
Practice Address - Fax:509-338-9206
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005587225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8421851Medicaid
WA0195910OtherDEPT LABOR & INDUSTRY
3523VAOtherASURIS NORTHWEST
WA0195910OtherDEPT LABOR & INDUSTRY