Provider Demographics
NPI:1740473057
Name:HARLEY, LAURA ANN (RPT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:HARLEY
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 CENTER AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3094
Mailing Address - Country:US
Mailing Address - Phone:714-904-4200
Mailing Address - Fax:714-903-9425
Practice Address - Street 1:5252 EL CAJON BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-4710
Practice Address - Country:US
Practice Address - Phone:714-901-4200
Practice Address - Fax:714-903-9425
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4668225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist