Provider Demographics
NPI:1861683344
Name:YOO, LAURA (DPT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:YOO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1332 LONDONTOWN BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6587
Mailing Address - Country:US
Mailing Address - Phone:443-531-5888
Mailing Address - Fax:
Practice Address - Street 1:1332 LONDONTOWN BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6587
Practice Address - Country:US
Practice Address - Phone:443-531-5888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22451225100000X
IA004104225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist