Healthcare Provider Details

I. General information

NPI: 1306761283
Provider Name (Legal Business Name): LAURA KAY SHOMODY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2585 LAFRANIER RD
TRAVERSE CITY MI
49686-8972
US

IV. Provider business mailing address

3566 MATADOR W APT 102
TRAVERSE CITY MI
49684-4301
US

V. Phone/Fax

Practice location:
  • Phone: 231-947-9511
  • Fax:
Mailing address:
  • Phone: 231-775-7670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5502006255
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: