Provider Demographics
NPI:1386865947
Name:NEWSOM, LAURA JEAN (PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JEAN
Last Name:NEWSOM
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 1:408 SUN BLOSSOM COURT
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-9567
Mailing Address - Country:US
Mailing Address - Phone:916-367-7683
Mailing Address - Fax:
Practice Address - Street 1:366 ELM AVE.
Practice Address - Street 2:SUITE 252
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603
Practice Address - Country:US
Practice Address - Phone:916-367-1888
Practice Address - Fax:916-729-1611
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23346225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist