MEDICARE: LAURIE APPLEGATE RPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PTH 4223	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51517955	OTHER	AL	BC/BS PROVIDER NUMBER

General Provider Information

NPI Number	:	1013927714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE APPLEGATE RPT

Provider Business Mailing Address
First Line	:	7088 UNIVERSITY CT
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-6992
Country	:	US
Telephone Number	:	334-396-1400
Fax Number	:	334-396-2727

Provider Business Practice Location Address
First Line	:	242 WINTON M BLOUNT LOOP
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-3501
Country	:	US
Telephone Number	:	334-279-5015
Fax Number	:	334-279-5028

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	07/08/2007

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