Provider Demographics
NPI:1356434625
Name:DEVANEY, LAURIE L (PT, ATC)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:L
Last Name:DEVANEY
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 CORTLAND DR
Mailing Address - Street 2:
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-2157
Mailing Address - Country:US
Mailing Address - Phone:860-875-4628
Mailing Address - Fax:860-872-1306
Practice Address - Street 1:14 DOG LN
Practice Address - Street 2:
Practice Address - City:STORRS MANSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06269-4249
Practice Address - Country:US
Practice Address - Phone:860-486-8615
Practice Address - Fax:860-486-8617
Is Sole Proprietor?:No
Enumeration Date:2006-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006559225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist