Provider Demographics
NPI:1194063909
Name:NEWCOMB, LAURA C (DPT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:C
Last Name:NEWCOMB
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:DUDGEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5629
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47716-5629
Mailing Address - Country:US
Mailing Address - Phone:812-745-7475
Mailing Address - Fax:812-401-3259
Practice Address - Street 1:2300 53RD AVE STE LL02
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722
Practice Address - Country:US
Practice Address - Phone:563-449-7000
Practice Address - Fax:563-449-7099
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA005106225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist