Provider Demographics
NPI:1477836195
Name:WOLTERS, LAURA K (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:K
Last Name:WOLTERS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1167 KONERT VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-7171
Mailing Address - Country:US
Mailing Address - Phone:573-291-3858
Mailing Address - Fax:
Practice Address - Street 1:1167 KONERT VALLEY DR
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-7171
Practice Address - Country:US
Practice Address - Phone:573-291-3858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070018715225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist