Provider Demographics
NPI:1558615963
Name:WINNER, LAURA (DPT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:WINNER
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 1:5 BON AIR RD
Mailing Address - Street 2:SUITE 129
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1143
Mailing Address - Country:US
Mailing Address - Phone:415-924-8900
Mailing Address - Fax:415-924-7149
Practice Address - Street 1:5 BON AIR RD
Practice Address - Street 2:SUITE 129
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939-1143
Practice Address - Country:US
Practice Address - Phone:415-924-8900
Practice Address - Fax:415-924-7149
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37959225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist