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Individual
MRS. LAURIE LAYTON BOULWARE
Active
Individual
MRS. LAURIE LAYTON BOULWARE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT, CSCS
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 28645
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT 28645
PT LICENSE
CA
Enumeration date
06/03/2006
Last updated
03/26/2014
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