Provider Demographics
NPI:1275741183
Name:LAIDLEY, KATIE LEE (PT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LEE
Last Name:LAIDLEY
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 1:560 COUNTRY CLUB PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6036
Mailing Address - Country:US
Mailing Address - Phone:541-683-5139
Mailing Address - Fax:541-683-5783
Practice Address - Street 1:560 COUNTRY CLUB PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6036
Practice Address - Country:US
Practice Address - Phone:541-683-5139
Practice Address - Fax:541-683-5783
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29209225100000X
OR5406225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP00662426OtherRAILROAD MEDICARE
OR137834Medicare PIN