Active NPI
Laurel Ann Taylor Kornblau
- Physical Therapist
- Salem, OR
National Provider Identifier
1487277422
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 63667
- Practice address
- 4049 Market St NE
Salem, OR 97301-1902 - Phone
- (970) 631-6006
- NPI assigned
- May 26, 2020
- 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 | 63667 | OR | Primary |
Addresses
Primary practice location
4049 Market St NE
Salem, OR 97301-1902
Mailing address
1513 Whitaker Dr SE Apt 211
Salem, OR 97317-5918
Phone (970) 631-6006
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 63667 | OR | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1590451200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1590451200000",
"number": "1487277422",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1513 WHITAKER DR SE APT 211",
"city": "SALEM",
"state": "OR",
"postal_code": "973175918",
"telephone_number": "970-631-6006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4049 MARKET ST NE",
"city": "SALEM",
"state": "OR",
"postal_code": "973011902",
"telephone_number": "970-631-6006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KORNBLAU",
"first_name": "LAUREL",
"middle_name": "ANN TAYLOR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-05-26",
"last_updated": "2020-05-26",
"certification_date": "2020-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OR",
"license": "63667",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.