Healthcare Provider Details

I. General information

NPI: 1710814256
Provider Name (Legal Business Name): HOLDEN LEE LAUGHMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 N BUSINESS, MO-5
CAMDENTON MO
65020
US

IV. Provider business mailing address

34831 HIGHWAY 21
LESTERVILLE MO
63654-8846
US

V. Phone/Fax

Practice location:
  • Phone: 573-346-5624
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2024044434
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: