Provider Demographics
NPI:1295183366
Name:PERRY, LAURA BRIANA (PT, DPT, CSCS)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:BRIANA
Last Name:PERRY
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4950 NE BELKNAP CT STE 107
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5114
Mailing Address - Country:US
Mailing Address - Phone:503-615-5969
Mailing Address - Fax:503-615-5971
Practice Address - Street 1:4950 NE BELKNAP CT STE 107
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5114
Practice Address - Country:US
Practice Address - Phone:503-615-5969
Practice Address - Fax:503-615-5971
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61707225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist