Provider Demographics
NPI:1689747578
Name:CROSBY, LAURA K (MS PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:K
Last Name:CROSBY
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:A
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS PT
Mailing Address - Street 1:UNIT A
Mailing Address - Street 2:140 EAST BOARDWALK DRIVE
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3153
Mailing Address - Country:US
Mailing Address - Phone:970-223-8293
Mailing Address - Fax:970-223-8219
Practice Address - Street 1:UNIT A
Practice Address - Street 2:140 EAST BOARDWALK DRIVE
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3153
Practice Address - Country:US
Practice Address - Phone:970-223-8293
Practice Address - Fax:970-223-8219
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7285225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC802242Medicare PIN