Provider Demographics
NPI:1245569615
Name:DORNINK, LAURA CAROL (PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:CAROL
Last Name:DORNINK
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 1:2855 STRATFIELD CT
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-8286
Mailing Address - Country:US
Mailing Address - Phone:770-889-9023
Mailing Address - Fax:
Practice Address - Street 1:2855 STRATFIELD CT
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-8286
Practice Address - Country:US
Practice Address - Phone:770-889-9023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0076352251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics