Provider Demographics
NPI:1821096033
Name:THERAPEUTIC LASER CENTER
Entity Type:Organization
Organization Name:THERAPEUTIC LASER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF NATURAL SCIENCE,
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, CLT
Authorized Official - Phone:541-772-7007
Mailing Address - Street 1:115 W STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-3607
Mailing Address - Country:US
Mailing Address - Phone:541-772-7007
Mailing Address - Fax:541-772-7771
Practice Address - Street 1:115 W STEWART AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-3607
Practice Address - Country:US
Practice Address - Phone:541-772-7007
Practice Address - Fax:541-772-7771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation