Provider Demographics
NPI:1275353708
Name:GUNDLACH, LAURIE JAMES (DPT)
Entity type:Individual
Prefix:MISS
First Name:LAURIE
Middle Name:JAMES
Last Name:GUNDLACH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6404
Mailing Address - Street 2:
Mailing Address - City:CARMEL BY THE SEA
Mailing Address - State:CA
Mailing Address - Zip Code:93921-6404
Mailing Address - Country:US
Mailing Address - Phone:504-909-0074
Mailing Address - Fax:
Practice Address - Street 1:201 9TH ST
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-6039
Practice Address - Country:US
Practice Address - Phone:504-909-0074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic