Provider Demographics
NPI:1689944878
Name:KOHOUT, LAURA (PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:KOHOUT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:COCHETEUX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:2652 W CANYON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4684
Mailing Address - Country:US
Mailing Address - Phone:619-660-8895
Mailing Address - Fax:619-660-8697
Practice Address - Street 1:10225 AUSTIN DR STE 106
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91978-1521
Practice Address - Country:US
Practice Address - Phone:619-660-8895
Practice Address - Fax:619-660-8697
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14497225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist