Provider Demographics
NPI:1558382614
Name:DUDLEY, LAURA HARRISON (LPT)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:HARRISON
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7594
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-0594
Mailing Address - Country:US
Mailing Address - Phone:252-443-0808
Mailing Address - Fax:252-451-9032
Practice Address - Street 1:901 N WINSTEAD AVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-8467
Practice Address - Country:US
Practice Address - Phone:252-937-0277
Practice Address - Fax:252-937-0287
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC903225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7210230Medicaid
NC126MYOtherBCBS
NC195518OtherMEDCOST
NC2241335OtherUNITED HEALTH CARE
NC650023480Medicare ID - Type UnspecifiedRAILROAD MEDICARE
NC195518OtherMEDCOST
NC7210230Medicaid