Provider Demographics
NPI:1215248059
Name:FREEMAN, LAURIE J (LMT)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:J
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 PROVINCE RD
Mailing Address - Street 2:
Mailing Address - City:GILMANTON
Mailing Address - State:NH
Mailing Address - Zip Code:03237-5527
Mailing Address - Country:US
Mailing Address - Phone:315-532-1007
Mailing Address - Fax:
Practice Address - Street 1:14471 MEADE ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:NY
Practice Address - Zip Code:13156-3255
Practice Address - Country:US
Practice Address - Phone:315-532-1007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-26
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006473225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist