Healthcare Provider Details

I. General information

NPI: 1336368869
Provider Name (Legal Business Name): LAURA MORRIS LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 W PARK PL SUITE 202
COEUR D ALENE ID
83814-2781
US

IV. Provider business mailing address

PO BOX 1239
COEUR D ALENE ID
83816-1239
US

V. Phone/Fax

Practice location:
  • Phone: 208-667-9839
  • Fax: 200-876-5616
Mailing address:
  • Phone: 208-667-9839
  • Fax: 208-765-6169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMA00012379
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: