Provider Demographics
NPI:1245480938
Name:ST. LAURENT, FRANCIS EDMOND (PTA)
Entity type:Individual
Prefix:
First Name:FRANCIS
Middle Name:EDMOND
Last Name:ST. LAURENT
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16565 N LARIAT DR
Mailing Address - Street 2:
Mailing Address - City:DOLAN SPRINGS
Mailing Address - State:AZ
Mailing Address - Zip Code:86441-9714
Mailing Address - Country:US
Mailing Address - Phone:802-683-9914
Mailing Address - Fax:928-767-3504
Practice Address - Street 1:2505 HUALAPAI MTN RD. STE E
Practice Address - Street 2:LIFEFITREHAB
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401
Practice Address - Country:US
Practice Address - Phone:877-718-4301
Practice Address - Fax:928-718-4303
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6513A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant