Provider Demographics
NPI:1104124668
Name:GUNTHER, LAURA L
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:GUNTHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 RUBY ST SE
Mailing Address - Street 2:SUITE F
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-6723
Mailing Address - Country:US
Mailing Address - Phone:360-943-4797
Mailing Address - Fax:
Practice Address - Street 1:100 RUBY ST SE
Practice Address - Street 2:SUITE F
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-6723
Practice Address - Country:US
Practice Address - Phone:360-943-4797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60093464225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist