Healthcare Provider Details

I. General information

NPI: 1689176984
Provider Name (Legal Business Name): LAURA BARRONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2018
Last Update Date: 03/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E MICHIGAN AVE
LANSING MI
48912-1800
US

IV. Provider business mailing address

1617 DOWNING ST
HASLETT MI
48840-8400
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-5252
  • Fax: 517-364-5296
Mailing address:
  • Phone: 248-505-7413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501016522
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: