Healthcare Provider Details

I. General information

NPI: 1760329403
Provider Name (Legal Business Name): LAUREN SHIFFMAN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6553 E BAYWOOD AVE STE 209
MESA AZ
85206-1754
US

IV. Provider business mailing address

533 W GUADALUPE RD UNIT 2112
MESA AZ
85210-7786
US

V. Phone/Fax

Practice location:
  • Phone: 480-272-7797
  • Fax:
Mailing address:
  • Phone: 480-272-7797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number013859
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: