Provider Demographics
NPI:1356786636
Name:ANSPACH, LAURA LYNN (DPT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNN
Last Name:ANSPACH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:LYNN
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2933 SHANDON RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-9521
Mailing Address - Country:US
Mailing Address - Phone:269-944-7837
Mailing Address - Fax:704-594-5356
Practice Address - Street 1:2400 PARK RD STE G-1
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-6072
Practice Address - Country:US
Practice Address - Phone:704-269-8874
Practice Address - Fax:704-594-5356
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14187225100000X
NCP141872251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist