Healthcare Provider Details

I. General information

NPI: 1487647707
Provider Name (Legal Business Name): LAURA C FIELDS PT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 12/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 94 BOX 2219
APO AE INCIRLIK
09824
TR

IV. Provider business mailing address

157 LEWIS ST
NORTH POLE AK
99705-7699
TR

V. Phone/Fax

Practice location:
  • Phone: 850-319-2259
  • Fax:
Mailing address:
  • Phone: 907-488-4978
  • Fax: 907-488-4976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT 8532
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: