Provider Demographics
NPI:1609112200
Name:STRAUT, LAURA CLEVENGER (DPT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:CLEVENGER
Last Name:STRAUT
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 1:660 E EAU GALLIE BLVD
Mailing Address - Street 2:
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4252
Mailing Address - Country:US
Mailing Address - Phone:321-773-8155
Mailing Address - Fax:321-773-8154
Practice Address - Street 1:417 5TH AVE
Practice Address - Street 2:APT 101
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-4224
Practice Address - Country:US
Practice Address - Phone:321-773-8155
Practice Address - Fax:321-773-8154
Is Sole Proprietor?:No
Enumeration Date:2012-12-31
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT-27422225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist