Healthcare Provider Details

I. General information

NPI: 1649752940
Provider Name (Legal Business Name): LAURA JEAN MARSHALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 FOREST RIDGE RD
CONCORD MA
01742-3830
US

IV. Provider business mailing address

4 RICHMOND SQ
PROVIDENCE RI
02906-5117
US

V. Phone/Fax

Practice location:
  • Phone: 978-254-5913
  • Fax: 833-291-4581
Mailing address:
  • Phone: 401-433-4172
  • Fax: 401-433-0612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL88611
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberLPT-32603
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: