Provider Demographics
NPI:1710945670
Name:TYMAS, LAURA (LPT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:TYMAS
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 N DUKE ST
Mailing Address - Street 2:STE 305
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-3048
Mailing Address - Country:US
Mailing Address - Phone:919-220-9001
Mailing Address - Fax:
Practice Address - Street 1:2609 N DUKE ST
Practice Address - Street 2:STE 305
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-3048
Practice Address - Country:US
Practice Address - Phone:919-220-9001
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8910225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211933Medicaid
NC7211933Medicaid