Provider Demographics
NPI:1154438729
Name:DEBOER, LAURA (PT)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:DEBOER
Suffix:
Gender:F
Credentials:PT
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 34
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:CT
Mailing Address - Zip Code:06757-0034
Mailing Address - Country:US
Mailing Address - Phone:860-927-4559
Mailing Address - Fax:860-927-3352
Practice Address - Street 1:64 MAPLE ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:CT
Practice Address - Zip Code:06757-0034
Practice Address - Country:US
Practice Address - Phone:860-927-4559
Practice Address - Fax:860-927-3352
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004720225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0800004720CT01OtherANTHEM BC/BS PROVIDER
NY437033OtherMVP PROVIDER
CTOV6316OtherHEALTH NET PROVIDER
CT15901OtherCIGNA ORTHONET PROVIDER
CT2288136OtherAETNA PROVIDER
CT64-04275OtherUNITED HEALTH CARE PROVID
NYP2057224OtherOXFORD OUR OF NETOWRK PRO
NYQB0381OtherEMPIRE BC/BS PROVIDER