Provider Demographics
NPI:1760911192
Name:HUMMEL, LAURA MARIE (CMT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:HUMMEL
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9077 FOOTHILLS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-7720
Mailing Address - Country:US
Mailing Address - Phone:916-367-7730
Mailing Address - Fax:
Practice Address - Street 1:9077 FOOTHILLS BLVD. SUITE 200
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747
Practice Address - Country:US
Practice Address - Phone:916-367-7730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9772225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist