Provider Demographics
NPI:1417283961
Name:HILLARD, LAURA JEAN (PT)
Entity Type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:JEAN
Last Name:HILLARD
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 1:2759 S CLARK ST
Mailing Address - Street 2:A
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-3720
Mailing Address - Country:US
Mailing Address - Phone:573-581-1880
Mailing Address - Fax:573-581-6678
Practice Address - Street 1:2759 S CLARK ST
Practice Address - Street 2:A
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-3720
Practice Address - Country:US
Practice Address - Phone:573-581-1880
Practice Address - Fax:573-581-6678
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009031649174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist