Provider Demographics
NPI:1295904811
Name:SUGRUE, LAURA RUTH (MSPT, OCS)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:RUTH
Last Name:SUGRUE
Suffix:
Gender:F
Credentials:MSPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 PEASE RD
Mailing Address - Street 2:
Mailing Address - City:BUXTON
Mailing Address - State:ME
Mailing Address - Zip Code:04093-6516
Mailing Address - Country:US
Mailing Address - Phone:585-748-9541
Mailing Address - Fax:
Practice Address - Street 1:1068 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-3792
Practice Address - Country:US
Practice Address - Phone:207-324-6789
Practice Address - Fax:844-292-4021
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3363225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist