Provider Demographics
NPI:1821053257
Name:CORMIER, LAURA CATHERINE (PT)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:CATHERINE
Last Name:CORMIER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:CATHY
Other - Middle Name:
Other - Last Name:CORMIER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:2518 19TH ST E
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-4907
Mailing Address - Country:US
Mailing Address - Phone:205-507-0880
Mailing Address - Fax:
Practice Address - Street 1:526 14TH ST
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-3434
Practice Address - Country:US
Practice Address - Phone:205-345-4441
Practice Address - Fax:205-758-8880
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH1967225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL201201528OtherTRICARE
AL51522639OtherBLUE CROSS BLUE SHIELD
AL51522640OtherBLUE CROSS BLUE SHIELD
AL529923260Medicaid
AL529923260Medicaid
AL201201528OtherTRICARE
AL051522639Medicare ID - Type Unspecified