Provider Demographics
NPI:1700899242
Name:BRAY-PRESCOTT, LAURA LEE (PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LEE
Last Name:BRAY-PRESCOTT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 N CAPITOL AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1288
Mailing Address - Country:US
Mailing Address - Phone:317-924-8636
Mailing Address - Fax:317-921-0237
Practice Address - Street 1:1815 N CAPITOL AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1288
Practice Address - Country:US
Practice Address - Phone:317-924-8636
Practice Address - Fax:317-921-0237
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05002882A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist