Provider Demographics
NPI:1629166228
Name:MOHUN, LAURA LEA (PT,ATC)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LEA
Last Name:MOHUN
Suffix:
Gender:F
Credentials:PT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10983 BEACON RD
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-2834
Mailing Address - Country:US
Mailing Address - Phone:530-582-1340
Mailing Address - Fax:
Practice Address - Street 1:11053 DONNER PASS RD
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4839
Practice Address - Country:US
Practice Address - Phone:530-587-4790
Practice Address - Fax:530-587-4815
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT162752251S0007X, 2251X0800X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT162750Medicare ID - Type Unspecified