Provider Demographics
NPI:1396086047
Name:MARANO, LAURA PRUETT (DPT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:PRUETT
Last Name:MARANO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:RAE
Other - Last Name:PRUETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:29803 SANTA MARGARITA PKWY
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-3609
Mailing Address - Country:US
Mailing Address - Phone:949-459-9010
Mailing Address - Fax:949-459-9020
Practice Address - Street 1:29803 SANTA MARGARITA PKWY
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-3609
Practice Address - Country:US
Practice Address - Phone:949-459-9010
Practice Address - Fax:949-459-9020
Is Sole Proprietor?:No
Enumeration Date:2013-03-05
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207798225100000X
GAPT010414225100000X
CAPT41206225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist