Provider Demographics
NPI:1780704700
Name:ZASLAVSKI, LAURA (PT)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:ZASLAVSKI
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 1:239 WISWALL RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-3531
Mailing Address - Country:US
Mailing Address - Phone:617-818-8586
Mailing Address - Fax:617-663-6239
Practice Address - Street 1:1651 BLUE HILL AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-2109
Practice Address - Country:US
Practice Address - Phone:617-296-3951
Practice Address - Fax:617-296-1036
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY67534OtherBLUE CROSS BLUE SHIELD
MA0309311Medicaid
MAY68547Medicare ID - Type Unspecified