Provider Demographics
NPI:1194126623
Name:BAEUMEL, LAURA (DPT, ATC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BAEUMEL
Suffix:
Gender:M
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1163 JOHNSON FERRY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-2764
Mailing Address - Country:US
Mailing Address - Phone:770-321-0155
Mailing Address - Fax:
Practice Address - Street 1:3365 PIEDMONT RD NE
Practice Address - Street 2:SUITE 1260
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1794
Practice Address - Country:US
Practice Address - Phone:404-504-9030
Practice Address - Fax:404-504-9745
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010361225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist