Provider Demographics
NPI:1033677018
Name:LAURENT, MATTHIEU (PT)
Entity type:Individual
Prefix:MR
First Name:MATTHIEU
Middle Name:
Last Name:LAURENT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 5TH AVENUE, 8TH FLOOR
Mailing Address - Street 2:SUITE 818
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001
Mailing Address - Country:US
Mailing Address - Phone:646-979-0905
Mailing Address - Fax:646-810-6489
Practice Address - Street 1:302 5TH AVENUE, 8TH FLOOR
Practice Address - Street 2:SUITE 818
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001
Practice Address - Country:US
Practice Address - Phone:646-979-0905
Practice Address - Fax:646-810-6489
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-07
Last Update Date:2019-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041960225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist