Provider Demographics
NPI:1730799644
Name:MIDURA, LAURA ANN (PT, DPT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:MIDURA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ANN
Other - Last Name:QUINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2800 S LAKELINE BLVD APT 613
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-1680
Mailing Address - Country:US
Mailing Address - Phone:737-704-6188
Mailing Address - Fax:
Practice Address - Street 1:2800 S LAKELINE BLVD APT 613
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-1680
Practice Address - Country:US
Practice Address - Phone:737-704-6188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1331607225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist