Basic Information
| Provider Information | |||||||||
| NPI: | 1144374323 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUSAK | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | KRISTEN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | ATC, LAT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 114 OVERLOOK VIEW DR | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287393607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286961834 | ||||||||
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| Practice Location | |||||||||
| Address1: | 204 S KING ST | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287925059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286921333 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 0153 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.