Provider Demographics
NPI:1750003158
Name:MCPIKE, LAURA (PTA)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:MCPIKE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 SE PRAIRIE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-8631
Mailing Address - Country:US
Mailing Address - Phone:515-217-0672
Mailing Address - Fax:610-925-7368
Practice Address - Street 1:1275 SW STATE ST
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-2545
Practice Address - Country:US
Practice Address - Phone:515-895-4560
Practice Address - Fax:515-216-5960
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08288225200000X
IA087138225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant