Healthcare Provider Details

I. General information

NPI: 1700015518
Provider Name (Legal Business Name): LAURIE G PRESTBY P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURIE BAKER P.T.

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 09/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 E PARADISE DR
WEST BEND WI
53095-5444
US

IV. Provider business mailing address

1700 W PARADISE DRIVE
WEST BEND WI
53095-9795
US

V. Phone/Fax

Practice location:
  • Phone: 262-306-6319
  • Fax: 262-306-2964
Mailing address:
  • Phone: 262-334-3451
  • Fax: 262-306-2964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2142
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: