Healthcare Provider Details

I. General information

NPI: 1093584187
Provider Name (Legal Business Name): LAUREN ST ONGE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2023
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 TURNPIKE DR UNIT 100
WESTMINSTER CO
80031-7042
US

IV. Provider business mailing address

3304 HICKOK PL
BOULDER CO
80301-1949
US

V. Phone/Fax

Practice location:
  • Phone: 303-430-2490
  • Fax:
Mailing address:
  • Phone: 404-862-8066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT016787
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: