Provider Demographics
NPI:1215308119
Name:ETRI, LAURELLE
Entity type:Individual
Prefix:
First Name:LAURELLE
Middle Name:
Last Name:ETRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2458 FLORIN CT
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-4802
Mailing Address - Country:US
Mailing Address - Phone:516-644-7048
Mailing Address - Fax:
Practice Address - Street 1:2458 FLORIN CT
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-4802
Practice Address - Country:US
Practice Address - Phone:516-644-7048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-18
Last Update Date:2015-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037875225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist