Provider Demographics
NPI:1538871611
Name:LAURA ELIZABETH PRENTICE
Entity type:Organization
Organization Name:LAURA ELIZABETH PRENTICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:PRENTICE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:508-472-5482
Mailing Address - Street 1:65 BOSTON POST RD W STE 130
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-1855
Mailing Address - Country:US
Mailing Address - Phone:508-481-5519
Mailing Address - Fax:580-848-1610
Practice Address - Street 1:65 BOSTON POST RD W STE 130
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-1855
Practice Address - Country:US
Practice Address - Phone:508-481-5519
Practice Address - Fax:508-481-6106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-20
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty