Provider Demographics
NPI:1730293143
Name:MAURO, LAURELL (PT)
Entity Type:Individual
Prefix:
First Name:LAURELL
Middle Name:
Last Name:MAURO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7033 EL MALABAR DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-1405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2240 E GONZALES RD
Practice Address - Street 2:STE. 260
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-8210
Practice Address - Country:US
Practice Address - Phone:805-981-5223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT174402251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics