Healthcare Provider Details

I. General information

NPI: 1275741183
Provider Name (Legal Business Name): KATIE LEE LAIDLEY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 COUNTRY CLUB PKWY SUITE B
EUGENE OR
97401-6036
US

IV. Provider business mailing address

560 COUNTRY CLUB PKWY SUITE B
EUGENE OR
97401-6036
US

V. Phone/Fax

Practice location:
  • Phone: 541-683-5139
  • Fax: 541-683-5783
Mailing address:
  • Phone: 541-683-5139
  • Fax: 541-683-5783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number29209
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5406
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierP00662426
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerRAILROAD MEDICARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: