Individual
MRS. LAURIE VALLONESHIMKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
1626 SHEFFIELD PL, ORANGE PARK, FL 32073-5268
(904) 269-7751
Mailing address
PO BOX 505, ORANGE PARK, FL 32067-0505
(904) 269-7751
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT0014414
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
675795996
MEDWAIVER PROVIDER NUMBER
FL
05
—
885134400
—
FL
Enumeration date
12/21/2005
Last updated
11/27/2013
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