Provider Demographics
NPI:1528481652
Name:DARNELL, LAURA (PT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:DARNELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:DARNELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:2327 MONTEZUMA DR
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-3826
Mailing Address - Country:US
Mailing Address - Phone:408-373-4189
Mailing Address - Fax:
Practice Address - Street 1:2327 MONTEZUMA DR
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-3826
Practice Address - Country:US
Practice Address - Phone:408-373-4189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14666208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty