Provider Demographics
NPI:1154615466
Name:THORENSEN, LAURA M (LMP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:THORENSEN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8361 22ND ST NE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-6483
Mailing Address - Country:US
Mailing Address - Phone:253-830-4284
Mailing Address - Fax:
Practice Address - Street 1:1728 W MARINE VIEW DR STE 212
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-2083
Practice Address - Country:US
Practice Address - Phone:425-418-3793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60187563225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist