MEDICARE: MRS. LAURA MARGARET WEIRUP 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	03736	IA

General Provider Information

NPI Number	:	1699830257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA MARGARET WEIRUP DPT

Provider Business Mailing Address
First Line	:	1693 NW 101ST ST
Second Line	:
City	:	CLIVE
State	:	IA
Zip	:	50325-6715
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1978 GRAND AVE
Second Line	:	SUITE 45
City	:	WEST DES MOINES
State	:	IA
Zip	:	50265-4217
Country	:	US
Telephone Number	:	515-221-2220
Fax Number	:

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

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	07/08/2007

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