Provider Demographics
NPI:1811957269
Name:PROBERT, LAURA A (MPT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:PROBERT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6845 ELM ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101
Mailing Address - Country:US
Mailing Address - Phone:703-556-4424
Mailing Address - Fax:703-556-4435
Practice Address - Street 1:6845 ELM ST
Practice Address - Street 2:SUITE 110
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101
Practice Address - Country:US
Practice Address - Phone:703-556-4424
Practice Address - Fax:703-556-4435
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305005189225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
496681Medicare ID - Type Unspecified