Provider Demographics
NPI:1699899294
Name:RING, LARA F (PT)
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:F
Last Name:RING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LARA
Other - Middle Name:
Other - Last Name:LOOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:1125 PINE KNOLLS RD
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-8232
Mailing Address - Country:US
Mailing Address - Phone:336-497-3072
Mailing Address - Fax:336-497-3072
Practice Address - Street 1:1125 PINE KNOLLS RD
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-8232
Practice Address - Country:US
Practice Address - Phone:336-497-3072
Practice Address - Fax:336-497-3072
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10601225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7212106Medicaid