Healthcare Provider Details

I. General information

NPI: 1588717391
Provider Name (Legal Business Name): LAURA ANNE BUMPUS P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 ONONDAGA LN
MEDFIELD MA
02052-2925
US

IV. Provider business mailing address

20 ONONDAGA LN
MEDFIELD MA
02052-2925
US

V. Phone/Fax

Practice location:
  • Phone: 508-359-6304
  • Fax:
Mailing address:
  • Phone: 508-359-6304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1251
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: