Provider Demographics
NPI:1275607574
Name:MCCURRY, LAURA NICOLE
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:NICOLE
Last Name:MCCURRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 VILLAGE DR APT A201
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-4864
Mailing Address - Country:US
Mailing Address - Phone:816-676-0843
Mailing Address - Fax:
Practice Address - Street 1:5506 CORPORATE DR STE 1800
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-7752
Practice Address - Country:US
Practice Address - Phone:816-232-9420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2002021828OtherLICENSE#