Provider Demographics
NPI:1790947059
Name:SCHLAUD, LAURA ELIZABETH (PTA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ELIZABETH
Last Name:SCHLAUD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2465 DICKENSON DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-4552
Mailing Address - Country:US
Mailing Address - Phone:586-489-3517
Mailing Address - Fax:
Practice Address - Street 1:38777 WEST 6 MILE ROAD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-2694
Practice Address - Country:US
Practice Address - Phone:734-452-0395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI09152008Medicaid
MI1026270915Medicare PIN
MI123456789Medicare Oscar/Certification
MI0702791114Medicare NSC
MI09152008Medicaid