MEDICARE: MS. LAURA ELIZABETH PRENTICE P.T.

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	8227	MA

General Provider Information

NPI Number	:	1215922208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURA ELIZABETH PRENTICE P.T.

Provider Business Mailing Address
First Line	:	62 WHIPPLE BROOK RD
Second Line	:
City	:	WRENTHAM
State	:	MA
Zip	:	02093-2512
Country	:	US
Telephone Number	:	508-472-5482
Fax Number	:

Provider Business Practice Location Address
First Line	:	62 WHIPPLE BROOK RD
Second Line	:
City	:	WRENTHAM
State	:	MA
Zip	:	02093-2512
Country	:	US
Telephone Number	:	508-472-5482
Fax Number	:

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

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	03/18/2021

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