Provider Demographics
NPI:1861673253
Name:VINCENT, LAURA M (PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:VINCENT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 242278
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36124-2278
Mailing Address - Country:US
Mailing Address - Phone:334-625-5795
Mailing Address - Fax:334-394-4905
Practice Address - Street 1:3950 COBB PKWY NW
Practice Address - Street 2:SUITE 103
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-9532
Practice Address - Country:US
Practice Address - Phone:770-917-0924
Practice Address - Fax:770-917-0926
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2015-06-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GAPT006583225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I650061Medicare PIN