Healthcare Provider Details

I. General information

NPI: 1811308752
Provider Name (Legal Business Name): MICHELE LAUER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 05/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 POSA PLACE
DARTMOUTH MA
02747
US

IV. Provider business mailing address

PO BOX 111
SOUND BEACH NY
11789-0111
US

V. Phone/Fax

Practice location:
  • Phone: 508-996-3391
  • Fax:
Mailing address:
  • Phone: 631-235-0381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number21061
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: