Active NPI
Laura M Prouty, PT
- Physical Therapist
- Green Bay, WI
National Provider Identifier
1770845174
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 12018
- Practice address
- 1630 Commanche Ave
Green Bay, WI 54313-5753 - Phone
- (920) 430-4700
- Fax
- (920) 430-4747
- NPI assigned
- Jun 12, 2012
- 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 | 12018 | WI | Primary |
Addresses
Primary practice location
1630 Commanche Ave
Green Bay, WI 54313-5753
Mailing address
PO Box 22487
Green Bay, WI 54305-2487
Phone (920) 445-7210
Other practice location 1
555 Redbird Cir
DE Pere, WI 54115-7977
Phone (920) 338-6870
Other practice location 2
3263 Eaton Rd
Green Bay, WI 54311-6830
Phone (920) 433-6700
Other practice location 3
744 S Webster Ave
Green Bay, WI 54301-3505
Phone (920) 433-7822
Other names 1
- Laura M Anderson
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 |
|---|---|---|---|
| 12018 | WI | MD | Physical Therapist |
Interoperability endpoints
- lprouty140952@direct.thedacare.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339459200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689724800000",
"number": "1770845174",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 22487",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543052487",
"telephone_number": "920-445-7210"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1630 COMMANCHE AVE",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543135753",
"telephone_number": "920-430-4700",
"fax_number": "920-430-4747"
}
],
"practiceLocations": [
{
"address_1": "555 Redbird Cir",
"address_purpose": "LOCATION",
"city": "DE Pere",
"state": "WI",
"postal_code": "541157977",
"country_code": "US",
"telephone_number": "920-338-6870",
"fax_number": "920-338-6829",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3263 Eaton Rd",
"address_purpose": "LOCATION",
"city": "Green Bay",
"state": "WI",
"postal_code": "543116830",
"country_code": "US",
"telephone_number": "920-433-6700",
"fax_number": "920-433-6719",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "744 S Webster Ave",
"address_purpose": "LOCATION",
"city": "Green Bay",
"state": "WI",
"postal_code": "543013505",
"country_code": "US",
"telephone_number": "920-433-7822",
"fax_number": "920-433-3651",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PROUTY",
"first_name": "LAURA",
"middle_name": "M",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-06-12",
"last_updated": "2023-07-19",
"certification_date": "2023-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "12018",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "LAURA",
"last_name": "ANDERSON",
"middle_name": "M",
"credential": "PT",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.