Provider Demographics
NPI:1083455224
Name:MIKOS, LAURA (DPT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MIKOS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 MOUNT PLEASANT CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-7376
Mailing Address - Country:US
Mailing Address - Phone:847-917-4288
Mailing Address - Fax:
Practice Address - Street 1:611 OLD US HWY 70 E
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-9488
Practice Address - Country:US
Practice Address - Phone:828-669-9991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP23229225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist