Provider Demographics
NPI:1871860122
Name:MINK, LAURA A (PT, DPT, CERT MDT)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:A
Last Name:MINK
Suffix:
Gender:F
Credentials:PT, DPT, CERT MDT
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:A
Other - Last Name:O'DONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2501 OAKINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN PROVING GROUND
Mailing Address - State:MD
Mailing Address - Zip Code:21005-5131
Mailing Address - Country:US
Mailing Address - Phone:410-306-4203
Mailing Address - Fax:
Practice Address - Street 1:2501 OAKINGTON ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN PROVING GROUND
Practice Address - State:MD
Practice Address - Zip Code:21005-5131
Practice Address - Country:US
Practice Address - Phone:410-278-5475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23873225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP01084188OtherMEDICARE RAILROAD
MD233031Y5FMedicare PIN