Healthcare Provider Details

I. General information

NPI: 1306061171
Provider Name (Legal Business Name): MS. LAURIE D. CARLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. LAURIE D. CARLSON-MURPHY

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14619 PURDY DR NW
GIG HARBOR WA
98332-8708
US

IV. Provider business mailing address

PO BOX 596
WAUNA WA
98395-0596
US

V. Phone/Fax

Practice location:
  • Phone: 253-278-7367
  • Fax:
Mailing address:
  • Phone: 253-278-7367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMA00017290
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: