Healthcare Provider Details

I. General information

NPI: 1366054967
Provider Name (Legal Business Name): LAURA MARIE ERNST PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA M SEADLER PT

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13847 W 63RD ST STE 2
SHAWNEE KS
66216-3800
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 913-962-7770
  • Fax: 913-962-7775
Mailing address:
  • Phone: 423-238-7217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2023016500
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4354
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-07307
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: