Provider Demographics
NPI:1518991579
Name:LEIFERT, LAURA KATHERINE (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:KATHERINE
Last Name:LEIFERT
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 1:144 E CANAAN RD
Mailing Address - Street 2:
Mailing Address - City:EAST CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06024-2600
Mailing Address - Country:US
Mailing Address - Phone:860-824-5142
Mailing Address - Fax:860-824-5142
Practice Address - Street 1:144 E CANAAN RD
Practice Address - Street 2:
Practice Address - City:EAST CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06024-2600
Practice Address - Country:US
Practice Address - Phone:860-824-5142
Practice Address - Fax:860-824-5142
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004378225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT650000276Medicare ID - Type Unspecified