1609880525 NPI number — LAURIE OSHAUGHNESSY PT SERVICES

Table of content: (NPI 1609880525)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609880525 NPI number — LAURIE OSHAUGHNESSY PT SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAURIE OSHAUGHNESSY PT SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CARNELIAN BAY PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
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:
1609880525
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1387
Provider Second Line Business Mailing Address:
215 CARNELIAN BAY AVE SUITE A
Provider Business Mailing Address City Name:
CARNELIAN BAY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96140-1387
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-546-7581
Provider Business Mailing Address Fax Number:
530-546-7869

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 CARNELIAN BAY ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
CARNELIAN BAY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-546-7581
Provider Business Practice Location Address Fax Number:
530-546-7869
Provider Enumeration Date:
07/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OSHAUGHNESSY
Authorized Official First Name:
LAURIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICAL THERAPIST OWNER
Authorized Official Telephone Number:
530-546-7581

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: OPT137040 . This is a "MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1679624613 . This is a "BROOKE BARRETT NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1184774218 . This is a "MICHELLE WILLIAMS NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1336298827 . This is a "LAURIE OSHAUGHNESSY NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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