Healthcare Provider Details

I. General information

NPI: 1144815986
Provider Name (Legal Business Name): LAUREN NICOLE SEBELLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2021
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7209 CURRY FORD RD STE E
ORLANDO FL
32822-5809
US

IV. Provider business mailing address

14816 HARTFORD RUN DR
ORLANDO FL
32828-7824
US

V. Phone/Fax

Practice location:
  • Phone: 407-421-7284
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA29102
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: