Provider Demographics
NPI:1386668747
Name:GUSE, LAURA (PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:GUSE
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 1:4745 ARBOR CT S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-4285
Mailing Address - Country:US
Mailing Address - Phone:701-297-9721
Mailing Address - Fax:
Practice Address - Street 1:240 CHESTNUT DR
Practice Address - Street 2:
Practice Address - City:HORACE
Practice Address - State:ND
Practice Address - Zip Code:58047-4005
Practice Address - Country:US
Practice Address - Phone:701-793-5729
Practice Address - Fax:701-282-9738
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1142225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist