Healthcare Provider Details

I. General information

NPI: 1760394209
Provider Name (Legal Business Name): LAUREN MACKENZIE FLETCHER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 PARK AVE
BRIDGEPORT CT
06604-1049
US

IV. Provider business mailing address

64 E MITCHELL AVE APT 38
CHESHIRE CT
06410-4173
US

V. Phone/Fax

Practice location:
  • Phone: 203-365-6443
  • Fax:
Mailing address:
  • Phone: 570-899-4711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15661
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: