Provider Demographics
NPI:1699101980
Name:TOWNSEND, LAURA LYNN (PT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNN
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 S RIVERSHORE LN
Mailing Address - Street 2:STE 120
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-4979
Mailing Address - Country:US
Mailing Address - Phone:208-938-8020
Mailing Address - Fax:208-938-8016
Practice Address - Street 1:533 S RIVERSHORE LN
Practice Address - Street 2:STE 120
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-4979
Practice Address - Country:US
Practice Address - Phone:208-938-8020
Practice Address - Fax:208-938-8016
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT 950225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist