Provider Demographics
NPI:1144307158
Name:HUTTER, LAURA BETH (PTA)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:BETH
Last Name:HUTTER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 SW WISPER BAY DR
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-1429
Mailing Address - Country:US
Mailing Address - Phone:772-463-7112
Mailing Address - Fax:772-463-7112
Practice Address - Street 1:227 SW MONTEREY RD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4646
Practice Address - Country:US
Practice Address - Phone:772-781-1690
Practice Address - Fax:772-781-1691
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA14235225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant