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NPI Code Detail

MEDICARE: LAUREL V ROOF MPT

MEDICARE: LAUREL V ROOF MPT
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
1225100000XPhysical Therapist4862OR

General Provider Information

NPI Number : 1568516136
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAUREL V ROOF MPT
Provider Business Mailing Address
First Line : 1736 22ND ST
Second Line :
City : HOOD RIVER
State : OR
Zip : 97031-8672
Country : US
Telephone Number : 541-380-0462
Fax Number :
Provider Business Practice Location Address
First Line : 2002 12TH ST
Second Line :
City : HOOD RIVER
State : OR
Zip : 97031-9543
Country : US
Telephone Number : 541-386-1211
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2007
Last Update Date : 07/08/2007

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Practice Location Address:
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97031-9543
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Directions to “ LAUREL V ROOF MPT” Practice Location

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