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General NPI Number Information
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NPI Number | 1245480938
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Entity Type | Individual
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Provider Name | FRANCIS EDMOND ST. LAURENT PTA
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Gender | Male
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Dates
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Enumeration Date | 09/30/2008
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Last Update Date | 09/30/2008
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Provider Practice Location Address
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Address Line | 2505 HUALAPAI MTN RD. STE E LIFEFITREHAB
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City | KINGMAN
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State | AZ
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Zip | 86401
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Country | US
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Telephone | 877-718-4301
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Fax | 928-718-4303
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Provider Business Mailing Address
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Address Line | 16565 N LARIAT DR
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City | DOLAN SPRINGS
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State | AZ
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Zip | 86441-9714
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Country | US
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Telephone | 802-683-9914
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Fax | 928-767-3504
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 6513A
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License Number State | AZ
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