Provider Demographics
NPI:1205239209
Name:ERGUIZA, LAARNI
Entity type:Individual
Prefix:MRS
First Name:LAARNI
Middle Name:
Last Name:ERGUIZA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LAARNI
Other - Middle Name:LISING
Other - Last Name:DIZON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:407 CHURCHILL DOWNS DR
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NC
Mailing Address - Zip Code:28315-3655
Mailing Address - Country:US
Mailing Address - Phone:910-691-7420
Mailing Address - Fax:
Practice Address - Street 1:407 CHURCHILL DOWNS DR
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-3655
Practice Address - Country:US
Practice Address - Phone:910-691-7420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12451225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist