Healthcare Provider Details

I. General information

NPI: 1770779191
Provider Name (Legal Business Name): LAURA ELIZABETH MOREY P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 E WATER ST
DESHLER OH
43516-1327
US

IV. Provider business mailing address

620 E WATER ST
DESHLER OH
43516-1327
US

V. Phone/Fax

Practice location:
  • Phone: 419-430-4039
  • Fax:
Mailing address:
  • Phone: 419-430-4039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number011224
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: