Provider Demographics
NPI:1265538714
Name:HOTTENDORF, LAURA (PT)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:HOTTENDORF
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 1:494 N HARBOR CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-6858
Mailing Address - Country:US
Mailing Address - Phone:321-610-7978
Mailing Address - Fax:321-610-7979
Practice Address - Street 1:494 N HARBOR CITY BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-6858
Practice Address - Country:US
Practice Address - Phone:321-610-7978
Practice Address - Fax:321-610-7979
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT7535225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY8175AMedicare ID - Type UnspecifiedMEDICARE NUMBER