Provider Demographics
NPI:1194890780
Name:OPSTEDAL, LAURA M (DPT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:OPSTEDAL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:M
Other - Last Name:KALINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:9840 PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:MT
Mailing Address - Zip Code:59741-8635
Mailing Address - Country:US
Mailing Address - Phone:406-640-2024
Mailing Address - Fax:406-258-0580
Practice Address - Street 1:21 NE ROMANCE HILL RD STE 101
Practice Address - Street 2:
Practice Address - City:BELFAIR
Practice Address - State:WA
Practice Address - Zip Code:98528
Practice Address - Country:US
Practice Address - Phone:360-275-6612
Practice Address - Fax:360-275-6658
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008528225100000X
MT48562251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA228242OtherL&I
WA8369225OtherCHPW
WA7563OPOtherREGENCE
WA8946319OtherL&I CRIME