Provider Demographics
NPI:1548448491
Name:WOZNIAK, LAURA ANN (RPT)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANN
Last Name:WOZNIAK
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:ANN
Other - Last Name:VAN DALEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:12543 WINFIELD SCOTT BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-5095
Mailing Address - Country:US
Mailing Address - Phone:321-436-3751
Mailing Address - Fax:321-206-0767
Practice Address - Street 1:770 KEENELAND PIKE
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3951
Practice Address - Country:US
Practice Address - Phone:866-650-7150
Practice Address - Fax:866-650-7150
Is Sole Proprietor?:No
Enumeration Date:2008-02-02
Last Update Date:2008-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0009946225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist