1023131133 NPI number — MISS LAURIE ELIZABETH HOUSE DPT

Table of content: MISS LAURIE ELIZABETH HOUSE DPT (NPI 1023131133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023131133 NPI number — MISS LAURIE ELIZABETH HOUSE DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOUSE
Provider First Name:
LAURIE
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023131133
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8951 GROVE SPRINGS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMMONDSPORT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14840-9739
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-569-3627
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7571 STATE ROUTE 54
Provider Second Line Business Practice Location Address:
REHAB SERVICES DEPT. , IRA DAVENPORT MEMORIAL HOSPITAL
Provider Business Practice Location Address City Name:
BATH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14810-9504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-776-8543
Provider Business Practice Location Address Fax Number:
607-776-8635
Provider Enumeration Date:
04/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  028887-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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