Provider Demographics
NPI:1821571258
Name:FANG, LAURA E (PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:E
Last Name:FANG
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 1:2 THE SQUARE AT LILLINGTON
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-8030
Mailing Address - Country:US
Mailing Address - Phone:910-893-2850
Mailing Address - Fax:910-984-1515
Practice Address - Street 1:2 THE SQUARE AT LILLINGTON
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-8030
Practice Address - Country:US
Practice Address - Phone:910-893-2850
Practice Address - Fax:910-984-1515
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP20981225100000X
HIPT-4631225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI99-0353213OtherUHA