Provider Demographics
NPI:1194865881
Name:LAUGHLIN, ELLENE MARIE (PT)
Entity Type:Individual
Prefix:
First Name:ELLENE
Middle Name:MARIE
Last Name:LAUGHLIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:746 S TEJON AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-3288
Mailing Address - Country:US
Mailing Address - Phone:816-225-5438
Mailing Address - Fax:
Practice Address - Street 1:216 E ORMAN AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-2144
Practice Address - Country:US
Practice Address - Phone:816-916-8116
Practice Address - Fax:816-965-5252
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01377225100000X
CO0019041225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist