Provider Demographics
NPI:1346544772
Name:LAURITZEN, KAREN WHITTAKER (MS PT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:WHITTAKER
Last Name:LAURITZEN
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4638 193RD PL SE
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-9310
Mailing Address - Country:US
Mailing Address - Phone:732-552-9422
Mailing Address - Fax:
Practice Address - Street 1:4160 86TH AVE SE
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-4121
Practice Address - Country:US
Practice Address - Phone:732-552-9422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-28
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5856225100000X
WA00008199225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist