Provider Demographics
NPI:1124451497
Name:FILTER, LAURA (PTA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:FILTER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 791989
Mailing Address - Street 2:
Mailing Address - City:PAIA
Mailing Address - State:HI
Mailing Address - Zip Code:96779-1989
Mailing Address - Country:US
Mailing Address - Phone:612-242-6320
Mailing Address - Fax:
Practice Address - Street 1:380 HUKU LII PL
Practice Address - Street 2:SUITE 105
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-7043
Practice Address - Country:US
Practice Address - Phone:612-242-6320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-09
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT9839225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant