Provider Demographics
NPI:1558436626
Name:VANCOTT, LAURIE (PT)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:VANCOTT
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 1:551 LONE PINE BLVD
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-9403
Mailing Address - Country:US
Mailing Address - Phone:541-296-7202
Mailing Address - Fax:
Practice Address - Street 1:2690 MAY ST
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-9786
Practice Address - Country:US
Practice Address - Phone:541-386-2441
Practice Address - Fax:541-386-5869
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4028225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR231814Medicaid
OR231814Medicaid