Healthcare Provider Details

I. General information

NPI: 1932448909
Provider Name (Legal Business Name): LAURA ANN PAQUET DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2013
Last Update Date: 02/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N 1ST ST
STAYTON OR
97383-1704
US

IV. Provider business mailing address

PO BOX 112
GATES OR
97346-0112
US

V. Phone/Fax

Practice location:
  • Phone: 503-769-3123
  • Fax: 503-769-3176
Mailing address:
  • Phone: 503-881-6351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number60103
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: