Provider Demographics
NPI:1023250834
Name:HUNTINGFORD, LAUREL P (PT)
Entity type:Individual
Prefix:MRS
First Name:LAUREL
Middle Name:P
Last Name:HUNTINGFORD
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 1:101 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3361
Mailing Address - Country:US
Mailing Address - Phone:252-261-1556
Mailing Address - Fax:252-261-6161
Practice Address - Street 1:503 CYPRESS LN
Practice Address - Street 2:SUITE A
Practice Address - City:MANTEO
Practice Address - State:NC
Practice Address - Zip Code:27954
Practice Address - Country:US
Practice Address - Phone:252-473-9633
Practice Address - Fax:252-473-1365
Is Sole Proprietor?:No
Enumeration Date:2009-03-26
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11750225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7212603Medicaid
NC069GMOtherBCBS
NC069GMOtherBCBS
NC2505923Medicare PIN