Provider Demographics
NPI:1871868885
Name:NEAL, LAURIE KAY (PT, DPT)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:KAY
Last Name:NEAL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 SOUTHPARK BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5190
Mailing Address - Country:US
Mailing Address - Phone:904-824-7787
Mailing Address - Fax:904-429-0318
Practice Address - Street 1:150 SOUTHPARK BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5190
Practice Address - Country:US
Practice Address - Phone:904-824-7787
Practice Address - Fax:904-429-0318
Is Sole Proprietor?:No
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT27169225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist