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General NPI Number Information
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NPI Number | 1194865881
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Entity Type | Individual
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Provider Name | ELLENE MARIE LAUGHLIN PT
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Gender | Female
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 08/02/2023
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Provider Practice Location Address
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Address Line | 216 E ORMAN AVE
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City | PUEBLO
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State | CO
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Zip | 81004-2144
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Country | US
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Telephone | 816-916-8116
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Fax | 816-965-5252
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Provider Business Mailing Address
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Address Line | 746 S TEJON AVE
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City | PUEBLO WEST
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State | CO
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Zip | 81007-3288
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Country | US
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Telephone | 816-225-5438
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 01377
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 0019041
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License Number State | CO
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