Provider Demographics
NPI:1588205850
Name:LAFAZIA, LAURA E (LMT, MMP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:E
Last Name:LAFAZIA
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:DE
Mailing Address - Zip Code:19956-1501
Mailing Address - Country:US
Mailing Address - Phone:302-448-1356
Mailing Address - Fax:
Practice Address - Street 1:501 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:DE
Practice Address - Zip Code:19956-1501
Practice Address - Country:US
Practice Address - Phone:302-448-1356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEMT-0003998225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist