Provider Demographics
NPI:1265575435
Name:LAISURE, VALERIE ANN (PT)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:ANN
Last Name:LAISURE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3519 LONGMEADOW DR
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-9334
Mailing Address - Country:US
Mailing Address - Phone:870-219-6030
Mailing Address - Fax:501-760-7442
Practice Address - Street 1:25255 HIGHWAY 5
Practice Address - Street 2:SUITEE N
Practice Address - City:LONSDALE
Practice Address - State:AR
Practice Address - Zip Code:72087-9519
Practice Address - Country:US
Practice Address - Phone:501-922-9911
Practice Address - Fax:501-922-9930
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2955225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist