Provider Demographics
NPI:1235607656
Name:BLEMASTER, LAURA KAY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:KAY
Last Name:BLEMASTER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1161 E CLARK RD STE 156
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-8312
Mailing Address - Country:US
Mailing Address - Phone:517-668-0000
Mailing Address - Fax:517-668-0017
Practice Address - Street 1:1161 E CLARK RD STE 156
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-8312
Practice Address - Country:US
Practice Address - Phone:517-668-0000
Practice Address - Fax:517-668-0017
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-03
Last Update Date:2018-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501018945261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy