Provider Demographics
NPI:1053432567
Name:MORRISON, LAURIE J
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:J
Last Name:MORRISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 355
Mailing Address - Street 2:11 BEAVER MEADOW RD
Mailing Address - City:NORWICH
Mailing Address - State:VT
Mailing Address - Zip Code:05055-0355
Mailing Address - Country:US
Mailing Address - Phone:802-649-5744
Mailing Address - Fax:802-649-5744
Practice Address - Street 1:11 BEAVER MEADOW RD
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:VT
Practice Address - Zip Code:05055-0355
Practice Address - Country:US
Practice Address - Phone:802-649-5744
Practice Address - Fax:802-649-5744
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0003242225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT065-28219OtherVT BCBS