Provider Demographics
NPI:1417952540
Name:FLETT, LAURA ANN SAYLOR (PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN SAYLOR
Last Name:FLETT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:YREKA PHYSICAL
Other - Middle Name:
Other - Last Name:THERAPY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1226
Mailing Address - Street 2:
Mailing Address - City:YREKA
Mailing Address - State:CA
Mailing Address - Zip Code:96097-1226
Mailing Address - Country:US
Mailing Address - Phone:530-842-4381
Mailing Address - Fax:530-842-9054
Practice Address - Street 1:205 EXECUTIVE CT
Practice Address - Street 2:
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-2629
Practice Address - Country:US
Practice Address - Phone:530-842-4381
Practice Address - Fax:530-842-9054
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2008-07-23
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
CAPT9272225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT0092720Medicaid
CA056802Medicare Oscar/Certification
056802Medicare ID - Type UnspecifiedMEDICARE