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General NPI Number Information
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NPI Number | 1720118003
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Entity Type | Individual
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Provider Name | LAURA L TIMMERMAN M.P.T.
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Gender | Female
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 01/18/2019
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Provider Practice Location Address
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Address Line | 196 E CENTER STREET SUITE 4
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City | BLANDING
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State | UT
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Zip | 84511-3620
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Country | US
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Telephone | 336-692-0155
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Fax |
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Provider Business Mailing Address
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Address Line | 293 W 100 NORTH
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City | BLANDING
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State | UT
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Zip | 84511-3620
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Country | US
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Telephone | 336-692-0155
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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 | 9376
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License Number State | NC
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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 | 11072404-2401
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License Number State | UT
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