Individual
MARK LAUREL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5980 W 71ST ST STE 102, INDIANAPOLIS, IN 46278-1785
(317) 388-0800
(317) 388-0805
Mailing address
5980 W 71ST ST STE 102, INDIANAPOLIS, IN 46278-1785
(317) 388-0800
(317) 388-0805
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
22361
MD
225100000X
Physical Therapist
4073
NM
Other
Enumeration date
10/06/2009
Last updated
02/11/2015
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