Healthcare Provider Details

I. General information

NPI: 1780082610
Provider Name (Legal Business Name): LAUREN JENNINGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3522 HARTSEL DR
COLORADO SPRINGS CO
80920-4165
US

IV. Provider business mailing address

3522 HARTSEL DR
COLORADO SPRINGS CO
80920-4165
US

V. Phone/Fax

Practice location:
  • Phone: 719-535-2757
  • Fax: 719-535-2767
Mailing address:
  • Phone: 719-535-2757
  • Fax: 719-535-2767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number13395
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: