MEDICARE: LAURA RAULERSON DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1053926840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA RAULERSON DPT

Provider Business Mailing Address
First Line	:	2857 CHARLESTOWN RD STE 200
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-0006
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2760 JEFFERSON CENTRE WAY STE 1
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-8266
Country	:	US
Telephone Number	:	812-288-8835
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2020
Last Update Date	:	09/09/2020

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