Provider Demographics
NPI:1497983738
Name:THORESON, LAURA A (DPT)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:A
Last Name:THORESON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-1729
Mailing Address - Country:US
Mailing Address - Phone:316-788-6734
Mailing Address - Fax:316-788-4529
Practice Address - Street 1:301 E MADISON AVE
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-1729
Practice Address - Country:US
Practice Address - Phone:316-788-6734
Practice Address - Fax:316-788-4529
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03943225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist