Provider Demographics
NPI:1205013364
Name:DENOVI, LAURA JEANNE (DOM, LAC)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:JEANNE
Last Name:DENOVI
Suffix:
Gender:F
Credentials:DOM, LAC
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:JEANNE
Other - Last Name:POTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:3346 STONEBRIDGE TRAIL
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596
Mailing Address - Country:US
Mailing Address - Phone:813-326-7523
Mailing Address - Fax:813-653-0894
Practice Address - Street 1:116 E BLOOMINGDALE AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8101
Practice Address - Country:US
Practice Address - Phone:813-655-3342
Practice Address - Fax:813-653-0894
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2023-07-12
Deactivation Date:2023-05-15
Deactivation Code:
Reactivation Date:2023-06-05
Provider Licenses
StateLicense IDTaxonomies
FLPTA19090225200000X
FLAP4456171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant