Provider Demographics
NPI:1427266725
Name:LAUER, JO ANN (CMTPT01)
Entity type:Individual
Prefix:
First Name:JO ANN
Middle Name:
Last Name:LAUER
Suffix:
Gender:F
Credentials:CMTPT01
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1261 LINCOLN AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-3006
Mailing Address - Country:US
Mailing Address - Phone:408-275-9434
Mailing Address - Fax:408-275-1638
Practice Address - Street 1:1261 LINCOLN AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-3006
Practice Address - Country:US
Practice Address - Phone:408-275-9434
Practice Address - Fax:408-275-1638
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAP01-90892081H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081H0002XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationHospice and Palliative Medicine