Provider Demographics
NPI:1922161041
Name:OSSOWSKI, LAURA L (MSPT)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:L
Last Name:OSSOWSKI
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W 116TH ST
Mailing Address - Street 2:#5B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-2081
Mailing Address - Country:US
Mailing Address - Phone:646-753-0674
Mailing Address - Fax:212-967-5545
Practice Address - Street 1:214 W 29TH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5203
Practice Address - Country:US
Practice Address - Phone:646-753-0674
Practice Address - Fax:212-967-5545
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023532225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ29H21Medicaid
NYQ29H21Medicaid