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General NPI Number Information
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NPI Number | 1407930464
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Entity Type | Individual
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Provider Name | LAUREL DOREMUS PT
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Gender | Female
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 46 TRINITY DR
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City | NOVATO
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State | CA
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Zip | 94947-5245
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Country | US
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Telephone | 415-847-2097
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Fax | 415-893-9931
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Provider Business Mailing Address
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Address Line | 115 RIDGE RD
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City | FAIRFAX
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State | CA
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Zip | 94930-1975
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Country | US
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Telephone | 415-233-0933
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Fax | 415-456-4132
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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 | PT19614
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License Number State | CA
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