Provider Demographics
NPI:1548267313
Name:SHOVE, LAURA B (PT)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:B
Last Name:SHOVE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:BARCLAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3020 CARBON PL STE 330
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-6169
Mailing Address - Country:US
Mailing Address - Phone:303-938-1141
Mailing Address - Fax:303-938-1311
Practice Address - Street 1:3020 CARBON PL STE 330
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-6169
Practice Address - Country:US
Practice Address - Phone:303-938-1141
Practice Address - Fax:303-938-1311
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4229225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO4229OtherPHYSICAL THERAPY LICENSE
COCR5963Medicare PIN