Provider Demographics
NPI:1679984223
Name:MIZUMOTO, LAURA (DPT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MIZUMOTO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7306 STINSON AVE
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1140
Mailing Address - Country:US
Mailing Address - Phone:425-776-0803
Mailing Address - Fax:425-776-0813
Practice Address - Street 1:7306 STINSON AVE
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1140
Practice Address - Country:US
Practice Address - Phone:253-858-3332
Practice Address - Fax:253-858-3327
Is Sole Proprietor?:No
Enumeration Date:2014-05-16
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60226057225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist