Provider Demographics
NPI:1306005020
Name:ROBERSON, LAUREL E (LMT)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:E
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4174 INVERRARY DR
Mailing Address - Street 2:702
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4578
Mailing Address - Country:US
Mailing Address - Phone:954-530-3411
Mailing Address - Fax:
Practice Address - Street 1:4407 SHERIDAN STREET
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33402
Practice Address - Country:US
Practice Address - Phone:954-893-7233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA5048173C00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist
No174400000XOther Service ProvidersSpecialist