Provider Demographics
NPI:1740551597
Name:GORHAM, LAURA CHRISTINE (PT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:CHRISTINE
Last Name:GORHAM
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 1:881 DOVER DR
Mailing Address - Street 2:SUITE 285
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-5962
Mailing Address - Country:US
Mailing Address - Phone:949-631-3321
Mailing Address - Fax:
Practice Address - Street 1:881 DOVER DR
Practice Address - Street 2:285
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-5962
Practice Address - Country:US
Practice Address - Phone:949-631-3321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT37048225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist