Provider Demographics
NPI:1427382019
Name:TROGLIN, LAURA M (PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:TROGLIN
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 1:1153 GULF BREEZE PKWY
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-7807
Mailing Address - Country:US
Mailing Address - Phone:850-932-6382
Mailing Address - Fax:850-932-9215
Practice Address - Street 1:340 REDSTONE AVE W
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-6433
Practice Address - Country:US
Practice Address - Phone:850-689-3127
Practice Address - Fax:850-689-8504
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 17771225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist