Provider Demographics
NPI:1457753303
Name:BROWN MEISENHEIMER, LAURA BETH (DPT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:BETH
Last Name:BROWN MEISENHEIMER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:BETH
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 CIRCLE 75 PKWY SE STE 1400
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3067
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:791 JOE FRANK HARRIS PKWY SE STE C
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2469
Practice Address - Country:US
Practice Address - Phone:678-719-7000
Practice Address - Fax:678-719-7003
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010880225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA13666630OtherCAQH
GA202I652389Medicare PIN