Healthcare Provider Details

I. General information

NPI: 1346544871
Provider Name (Legal Business Name): LAUREN GRACE LIEDER P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2010
Last Update Date: 12/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 TOWER WAY SUITE 207
BAKERSFIELD CA
93309-1585
US

IV. Provider business mailing address

4101 EASTON DR
BAKERSFIELD CA
93309-1021
US

V. Phone/Fax

Practice location:
  • Phone: 661-873-7975
  • Fax: 661-616-9199
Mailing address:
  • Phone: 661-377-1700
  • Fax: 661-616-9199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT37336
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: