Provider Demographics
NPI:1578860037
Name:FELTY, LAURA FAY (CMT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:FAY
Last Name:FELTY
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:FELTY
Other - Last Name:JOHANNSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CMT
Mailing Address - Street 1:3348 SHERMAN CT
Mailing Address - Street 2:SUITE #103
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-5006
Mailing Address - Country:US
Mailing Address - Phone:651-325-8778
Mailing Address - Fax:
Practice Address - Street 1:3348 SHERMAN CT
Practice Address - Street 2:SUITE #103
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-5006
Practice Address - Country:US
Practice Address - Phone:651-325-8778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMT-93-2010-2011172M00000X, 173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
No173C00000XOther Service ProvidersReflexologist