Provider Demographics
NPI:1063624617
Name:HARRIS, LAURA MICHELLE (MSPT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MICHELLE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-7049
Mailing Address - Country:US
Mailing Address - Phone:360-759-1500
Mailing Address - Fax:
Practice Address - Street 1:5400 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-7049
Practice Address - Country:US
Practice Address - Phone:360-759-1500
Practice Address - Fax:360-729-3314
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2867225100000X
WA6316225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist