Provider Demographics
NPI:1306061171
Name:CARLSON, LAURIE D
Entity type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:D
Last Name:CARLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LAURIE
Other - Middle Name:D
Other - Last Name:CARLSON-MURPHY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 596
Mailing Address - Street 2:
Mailing Address - City:WAUNA
Mailing Address - State:WA
Mailing Address - Zip Code:98395-0596
Mailing Address - Country:US
Mailing Address - Phone:253-278-7367
Mailing Address - Fax:
Practice Address - Street 1:14619 PURDY DR NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-8708
Practice Address - Country:US
Practice Address - Phone:253-278-7367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017290172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist