Active NPI
Laurie Layton Boulware, PT, DPT, CSCS
- Physical Therapist
- Mission Viejo, CA
National Provider Identifier
1093753741
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT 28645
- Practice address
- 26921 Crown Valley Pkwy
Suite 120
Mission Viejo, CA 92691-6501 - Phone
- (949) 582-2555
- NPI assigned
- Jun 3, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT 28645 | CA | Primary |
Addresses
Primary practice location
26921 Crown Valley Pkwy
Suite 120
Mission Viejo, CA 92691-6501
Mailing address
2111 San Joaquin Hills Rd
Newport Beach, CA 92660-6507
Phone (949) 721-9400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PT 28645 | Other | CA | PT LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT 28645 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149292800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395792000000",
"number": "1093753741",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2111 SAN JOAQUIN HILLS RD",
"city": "NEWPORT BEACH",
"state": "CA",
"postal_code": "926606507",
"telephone_number": "949-721-9400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26921 CROWN VALLEY PKWY",
"address_2": "SUITE 120",
"city": "MISSION VIEJO",
"state": "CA",
"postal_code": "926916501",
"telephone_number": "949-582-2555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOULWARE",
"first_name": "LAURIE",
"middle_name": "LAYTON",
"name_prefix": "Mrs.",
"credential": "PT, DPT, CSCS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-03",
"last_updated": "2014-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT 28645",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PT LICENSE",
"identifier": "PT 28645",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mission Viejo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.