Healthcare Provider Details

I. General information

NPI: 1689358574
Provider Name (Legal Business Name): LAUREN- ASHLEIGH PIATT PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44501 16TH ST W STE 107
LANCASTER CA
93534-2884
US

IV. Provider business mailing address

14678 GRANDRUE PL
CHINO HILLS CA
91709-4387
US

V. Phone/Fax

Practice location:
  • Phone: 661-974-7033
  • Fax:
Mailing address:
  • Phone: 909-247-6070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number304107
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: