Provider Demographics
NPI:1104266535
Name:BRINKMAN, LAURA ELIZABETH
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ELIZABETH
Last Name:BRINKMAN
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 1:534 S IROQUOIS ST
Mailing Address - Street 2:
Mailing Address - City:GOODLAND
Mailing Address - State:IN
Mailing Address - Zip Code:47948-8150
Mailing Address - Country:US
Mailing Address - Phone:219-863-7416
Mailing Address - Fax:
Practice Address - Street 1:11921 CANYON RD E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-4403
Practice Address - Country:US
Practice Address - Phone:253-970-8256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-29
Last Update Date:2013-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60340742225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist