Provider Demographics
NPI:1124678206
Name:CARLEY, LAURA ANN (PT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:CARLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23374 SUNSHINE LN
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-7805
Mailing Address - Country:US
Mailing Address - Phone:712-310-1264
Mailing Address - Fax:
Practice Address - Street 1:11640 ARBOR ST STE 200
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-5007
Practice Address - Country:US
Practice Address - Phone:402-933-8383
Practice Address - Fax:402-933-8382
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4025225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist