Provider Demographics
NPI:1548388002
Name:ROBERTS, LAURA WILLGOOSE (PT)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:WILLGOOSE
Last Name:ROBERTS
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 1:286 AURIELLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-6731
Mailing Address - Country:US
Mailing Address - Phone:802-862-6617
Mailing Address - Fax:
Practice Address - Street 1:1110 PRIM ROAD
Practice Address - Street 2:VISITING NURSE ASSOC OF CHITTENDEN & GRAND ISLE CO
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446
Practice Address - Country:US
Practice Address - Phone:802-658-1900
Practice Address - Fax:802-860-4454
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400000888225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist