Provider Demographics
NPI:1588605034
Name:EFTA, LAURA M (MSPT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:EFTA
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:M
Other - Last Name:JURVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:25012 104TH AVE SE
Practice Address - Street 2:SUITE C
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-2821
Practice Address - Country:US
Practice Address - Phone:253-856-3477
Practice Address - Fax:253-856-3478
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2015-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008214225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA007OtherTRICARE
WA135571OtherDEPT OF LABOR AND INDUSTR
WA8344871Medicaid
WA8935169OtherCRIME VICTIMS
WA2857EFOtherREGENCE BLUE SHIELD
WA650018956OtherRAILROAD MEDICARE
WA650018957OtherRAILROAD MEDICARE
WA650018957OtherRAILROAD MEDICARE
WAAB16699Medicare ID - Type UnspecifiedPIERCE COUNTY
WAAB16698Medicare ID - Type UnspecifiedKING COUNTY