Provider Demographics
NPI:1861780397
Name:CHRISTIAN, LAURA LEE (PT)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:LEE
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:LEE
Other - Last Name:CHRISTIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:6001 GORRION ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-2057
Mailing Address - Country:US
Mailing Address - Phone:602-478-6797
Mailing Address - Fax:
Practice Address - Street 1:6001 GORRION ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-2057
Practice Address - Country:US
Practice Address - Phone:602-478-6797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5493225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist