Healthcare Provider Details

I. General information

NPI: 1659154755
Provider Name (Legal Business Name): LAURA ASHLEY LOUIE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 ELLIS ST
SAN FRANCISCO CA
94115-4215
US

IV. Provider business mailing address

1822 47TH AVE
SAN FRANCISCO CA
94122-3918
US

V. Phone/Fax

Practice location:
  • Phone: 415-567-2967
  • Fax:
Mailing address:
  • Phone: 415-505-2865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT304192
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: