Provider Demographics
NPI:1407930464
Name:DOREMUS, LAUREL (PT)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:
Last Name:DOREMUS
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 1:115 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-1975
Mailing Address - Country:US
Mailing Address - Phone:415-233-0933
Mailing Address - Fax:415-456-4132
Practice Address - Street 1:46 TRINITY DR
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-5245
Practice Address - Country:US
Practice Address - Phone:415-847-2097
Practice Address - Fax:415-893-9931
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19614225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT19614OtherMEDICARE PIN NUMBER