Provider Demographics
NPI:1164474706
Name:GAGNON, LAURA HORVATH (PT, PH D)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:HORVATH
Last Name:GAGNON
Suffix:
Gender:F
Credentials:PT, PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 COLONIAL CIR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37803-2676
Mailing Address - Country:US
Mailing Address - Phone:865-384-5593
Mailing Address - Fax:865-980-1728
Practice Address - Street 1:2140 COLONIAL CIR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37803-2676
Practice Address - Country:US
Practice Address - Phone:865-384-5593
Practice Address - Fax:865-980-1728
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5944225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist