Provider Demographics
NPI:1184286197
Name:GUETH, LAUREL
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:
Last Name:GUETH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAUREL
Other - Middle Name:
Other - Last Name:JAROCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16 MAYBROOK RD STE D
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL HALL
Mailing Address - State:NY
Mailing Address - Zip Code:10916-2741
Mailing Address - Country:US
Mailing Address - Phone:845-636-4344
Mailing Address - Fax:
Practice Address - Street 1:502 MCKNIGHT DR STE 103
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-7050
Practice Address - Country:US
Practice Address - Phone:919-217-8820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP18771225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist