Provider Demographics
NPI:1720118003
Name:TIMMERMAN, LAURA L (MPT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:TIMMERMAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:L
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:293 W 100 NORTH
Mailing Address - Street 2:
Mailing Address - City:BLANDING
Mailing Address - State:UT
Mailing Address - Zip Code:84511-3620
Mailing Address - Country:US
Mailing Address - Phone:336-692-0155
Mailing Address - Fax:
Practice Address - Street 1:196 E CENTER STREET SUITE 4
Practice Address - Street 2:
Practice Address - City:BLANDING
Practice Address - State:UT
Practice Address - Zip Code:84511-3620
Practice Address - Country:US
Practice Address - Phone:336-692-0155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9376225100000X
UT11072404-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist