Provider Demographics
NPI:1528152410
Name:NEVILLE, LAURA P (MSPT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:P
Last Name:NEVILLE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:J
Other - Last Name:PROCTOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:1 ADLER DR
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-1223
Mailing Address - Country:US
Mailing Address - Phone:315-469-1189
Mailing Address - Fax:315-492-0548
Practice Address - Street 1:1 ADLER DR
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-1223
Practice Address - Country:US
Practice Address - Phone:315-469-1189
Practice Address - Fax:315-492-0548
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022224-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist