Provider Demographics
NPI:1194793463
Name:WILTSHIRE, LAURA (PT)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:WILTSHIRE
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 1:319A SOUTHBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-2598
Mailing Address - Country:US
Mailing Address - Phone:508-832-2628
Mailing Address - Fax:
Practice Address - Street 1:319A SOUTHBRIDGE ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-2598
Practice Address - Country:US
Practice Address - Phone:508-832-2628
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17248225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA81093OtherFALLON
MA81093OtherFALLON