Healthcare Provider Details

I. General information

NPI: 1851083513
Provider Name (Legal Business Name): LAUREN MICHELLE HERRIOTT PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN MICHELLE CIFELLI PT, DPT

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3633 VISTA WAY
OCEANSIDE CA
92056-4568
US

IV. Provider business mailing address

418 SHIRLEY DR
SAN MARCOS CA
92069-1806
US

V. Phone/Fax

Practice location:
  • Phone: 760-729-7298
  • Fax:
Mailing address:
  • Phone: 845-863-7257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number304125
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: