Provider Demographics
NPI:1346474079
Name:ANDERSON, LAURA LYNN (DPT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7834 N 153RD ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68007-1565
Mailing Address - Country:US
Mailing Address - Phone:402-210-6120
Mailing Address - Fax:
Practice Address - Street 1:7834 N 153RD ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:NE
Practice Address - Zip Code:68007-1565
Practice Address - Country:US
Practice Address - Phone:402-210-6120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-09
Last Update Date:2021-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2132225100000X
IA03826225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist