Provider Demographics
NPI:1659585917
Name:MERCHANT, LAURA LEE (PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LEE
Last Name:MERCHANT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 DICK RD
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-6477
Mailing Address - Country:US
Mailing Address - Phone:406-453-8761
Mailing Address - Fax:406-455-2626
Practice Address - Street 1:500 15TH AVE S
Practice Address - Street 2:BENEFIS THERAPY CENTER
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4324
Practice Address - Country:US
Practice Address - Phone:406-455-2614
Practice Address - Fax:406-455-2626
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT637225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist