Provider Demographics
NPI:1629166228
Name:MOHUN, LAURA LEA (PT,ATC)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LEA
Last Name:MOHUN
Suffix:
Gender:F
Credentials:PT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10983 BEACON RD
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-2834
Mailing Address - Country:US
Mailing Address - Phone:530-582-1340
Mailing Address - Fax:
Practice Address - Street 1:11053 DONNER PASS RD
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4839
Practice Address - Country:US
Practice Address - Phone:530-587-4790
Practice Address - Fax:530-587-4815
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT162752251S0007X, 2251X0800X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT162750Medicare ID - Type Unspecified