Provider Demographics
NPI:1265951461
Name:NAGODE, LAURA MICHELLE (PT, DPT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MICHELLE
Last Name:NAGODE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 BROOKHAVEN RD STE 201
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:KY
Mailing Address - Zip Code:42134-2746
Mailing Address - Country:US
Mailing Address - Phone:270-598-4935
Mailing Address - Fax:
Practice Address - Street 1:1100 BROOKHAVEN RD
Practice Address - Street 2:SUITE 201
Practice Address - City:FRANKLIN
Practice Address - State:KY
Practice Address - Zip Code:42134
Practice Address - Country:US
Practice Address - Phone:270-598-4935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6541225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist