Provider Demographics
NPI:1801063318
Name:EASTWOOD, LAURA (PT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:EASTWOOD
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 1:6433 US ROUTE 60 E
Mailing Address - Street 2:SUITE 125
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-1252
Mailing Address - Country:US
Mailing Address - Phone:304-736-3094
Mailing Address - Fax:304-936-3149
Practice Address - Street 1:6433 US ROUTE 60 E
Practice Address - Street 2:SUITE 125
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1252
Practice Address - Country:US
Practice Address - Phone:304-736-3094
Practice Address - Fax:304-936-3149
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002453225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist