Provider Demographics
NPI:1811122658
Name:HART, LAURA (LMP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 MILDRED ST W
Mailing Address - Street 2:STE# 100C
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6036
Mailing Address - Country:US
Mailing Address - Phone:253-564-2920
Mailing Address - Fax:253-564-0135
Practice Address - Street 1:2310 MILDRED ST W
Practice Address - Street 2:STE # 100C
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-6036
Practice Address - Country:US
Practice Address - Phone:253-564-2920
Practice Address - Fax:253-564-0135
Is Sole Proprietor?:No
Enumeration Date:2009-05-22
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist