Provider Demographics
NPI:1669408894
Name:MARUSICH, LAURA G (MPT)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:G
Last Name:MARUSICH
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 MEADOW OAKS CT
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932-3125
Mailing Address - Country:US
Mailing Address - Phone:915-581-2128
Mailing Address - Fax:
Practice Address - Street 1:1300 COUNTRY CLUB RD
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-9449
Practice Address - Country:US
Practice Address - Phone:575-589-0303
Practice Address - Fax:575-589-4080
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1104172225100000X
NM3098225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B6277Medicare PIN