Provider Demographics
NPI:1689797797
Name:HERBERHOLZ, LAURA (CTRS)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:HERBERHOLZ
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 FALCONWOOD RD APT 3
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-7820
Mailing Address - Country:US
Mailing Address - Phone:502-253-7500
Mailing Address - Fax:
Practice Address - Street 1:10510 LAGRANGE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-1277
Practice Address - Country:US
Practice Address - Phone:502-253-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist