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General NPI Number Information
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NPI Number | 1174080550
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Entity Type | Individual
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Provider Name | LAURA LYNN PETERS
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Gender | Female
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Dates
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Enumeration Date | 02/21/2019
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Last Update Date | 02/21/2019
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Provider Practice Location Address
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Address Line | 865 N DESERT BELL BLDG J
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City | GREEN VALLEY
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State | AZ
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Zip | 85614-2558
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Country | US
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Telephone | 520-308-0715
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Fax |
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Provider Business Mailing Address
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Address Line | 14428 S VIA DEL MORO
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City | SAHUARITA
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State | AZ
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Zip | 85629-8453
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Country | US
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Telephone | 502-308-0517
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT-25581
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License Number State | AZ
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