Provider Demographics
NPI:1720449192
Name:STOFFER, LAURIE (PT)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:STOFFER
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 1:10646 OAKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:OH
Mailing Address - Zip Code:44609-9298
Mailing Address - Country:US
Mailing Address - Phone:330-831-1279
Mailing Address - Fax:330-584-2272
Practice Address - Street 1:885 S SAWBURG AVE
Practice Address - Street 2:SUITE 216
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-5926
Practice Address - Country:US
Practice Address - Phone:330-596-6400
Practice Address - Fax:330-821-1955
Is Sole Proprietor?:No
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8849225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist