Provider Demographics
NPI:1902171200
Name:ULYATE, LAURA JOANNE (MPT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JOANNE
Last Name:ULYATE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28241 CROWN VALLEY PKWY
Mailing Address - Street 2:STE F321
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-4441
Mailing Address - Country:US
Mailing Address - Phone:949-292-3068
Mailing Address - Fax:
Practice Address - Street 1:20382 BARENTS SEA CIR
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-8807
Practice Address - Country:US
Practice Address - Phone:949-292-3068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 38767225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist