Provider Demographics
NPI:1336368869
Name:MORRIS, LAURA (LMP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MORRIS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83816-1239
Mailing Address - Country:US
Mailing Address - Phone:208-667-9839
Mailing Address - Fax:208-765-6169
Practice Address - Street 1:1110 W PARK PL
Practice Address - Street 2:SUITE 202
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2781
Practice Address - Country:US
Practice Address - Phone:208-667-9839
Practice Address - Fax:200-876-5616
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012379172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist