Healthcare Provider Details

I. General information

NPI: 1841155876
Provider Name (Legal Business Name): LAUREL E FOURNIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 NORTH ST STE D
HYANNIS MA
02601-3825
US

IV. Provider business mailing address

1175 OLD STAGE RD
CENTERVILLE MA
02632-2052
US

V. Phone/Fax

Practice location:
  • Phone: 508-775-6685
  • Fax: 508-771-5774
Mailing address:
  • Phone: 508-367-0288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL89015
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: