Basic Information
Provider Information | |||||||||
NPI: | 1447250063 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CAHAN | ||||||||
FirstName: | LAURA | ||||||||
MiddleName: | DAWSON | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | DAWSON | ||||||||
OtherFirstName: | LAURA | ||||||||
OtherMiddleName: | PATRICE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 15 SADDLE CT | ||||||||
Address2: |   | ||||||||
City: | SINKING SPRING | ||||||||
State: | PA | ||||||||
PostalCode: | 196089512 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6107776934 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1011 W PENN AVE | ||||||||
Address2: |   | ||||||||
City: | ROBESONIA | ||||||||
State: | PA | ||||||||
PostalCode: | 195519550 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6105892263 | ||||||||
FaxNumber: | 6105892232 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/26/2005 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | X | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT002017E | PA | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
ID Information
ID | Type | State | Issuer | Description | 156284 | 05 | PA |   | MEDICAID |