Provider Demographics
NPI:1669681243
Name:JEFFREY, LAURA KATHLEEN (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:KATHLEEN
Last Name:JEFFREY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:KATHLEEN
Other - Last Name:YOST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:6563 W MAIN ST LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-4051
Mailing Address - Country:US
Mailing Address - Phone:269-488-3320
Mailing Address - Fax:269-372-6113
Practice Address - Street 1:6563 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-4051
Practice Address - Country:US
Practice Address - Phone:269-372-8483
Practice Address - Fax:269-372-6113
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010128712251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP34790007Medicare PIN