Healthcare Provider Details

I. General information

NPI: 1396091419
Provider Name (Legal Business Name): LAUREN DEUELL DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2012
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3791 OLD CANOE CREEK RD
SAINT CLOUD FL
34769-6630
US

IV. Provider business mailing address

1536 3RD AVE 5TH FL
NEW YORK NY
10028-2167
US

V. Phone/Fax

Practice location:
  • Phone: 914-946-5685
  • Fax: 914-946-0304
Mailing address:
  • Phone: 212-861-2630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT31229
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: