MEDICARE: DR. LAUREN RENEE SANDIDGE DPT, PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1406176	TX

General Provider Information

NPI Number	:	1982400156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAUREN RENEE SANDIDGE DPT, PT

Provider Business Mailing Address
First Line	:	133 VENTI CV
Second Line	:
City	:	GEORGETOWN
State	:	TX
Zip	:	78628-2173
Country	:	US
Telephone Number	:	704-359-7661
Fax Number	:

Provider Business Practice Location Address
First Line	:	7840 FM 1960 RD E STE AND409
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77346-2259
Country	:	US
Telephone Number	:	281-812-6665
Fax Number	:	281-812-6869

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2025
Last Update Date	:	03/26/2026

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