Provider Demographics
NPI:1447647631
Name:IMIG, LAURA (MS, ATC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:IMIG
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14320 RANCH RD NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-9547
Mailing Address - Country:US
Mailing Address - Phone:402-658-6456
Mailing Address - Fax:
Practice Address - Street 1:14320 RANCH RD NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-9547
Practice Address - Country:US
Practice Address - Phone:402-658-6456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-25
Last Update Date:2015-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer