Provider Demographics
NPI:1972857001
Name:STARR, LAURA RUTH (PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:RUTH
Last Name:STARR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7525 E BROADWAY RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85208-2002
Mailing Address - Country:US
Mailing Address - Phone:480-354-2911
Mailing Address - Fax:480-984-3169
Practice Address - Street 1:7525 E BROADWAY RD
Practice Address - Street 2:SUITE 6
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85208-2002
Practice Address - Country:US
Practice Address - Phone:480-354-2911
Practice Address - Fax:480-984-3169
Is Sole Proprietor?:No
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10053PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist