Provider Demographics
NPI:1578357513
Name:WASHBURN, LAURA (LMT)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:WASHBURN
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11728 S 3600 W STE D
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-5935
Mailing Address - Country:US
Mailing Address - Phone:801-410-0106
Mailing Address - Fax:
Practice Address - Street 1:11728 S 3600 W STE D
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-5935
Practice Address - Country:US
Practice Address - Phone:801-410-0106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10564666-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist