Provider Demographics
NPI:1891498671
Name:MOUNTAIN LAUREL PHYSICAL THERAPY AND REHABILITATION
Entity Type:Organization
Organization Name:MOUNTAIN LAUREL PHYSICAL THERAPY AND REHABILITATION
Other - Org Name:MOUNTAIN LAUREL PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:515-473-4725
Mailing Address - Street 1:10574 GREENBELT DR
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-6617
Mailing Address - Country:US
Mailing Address - Phone:515-473-4725
Mailing Address - Fax:
Practice Address - Street 1:8365 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-1124
Practice Address - Country:US
Practice Address - Phone:515-473-4725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-22
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty