Healthcare Provider Details

I. General information

NPI: 1811150097
Provider Name (Legal Business Name): MRS. LAUREN THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5330 LAYTHAM PIKE
MAYSLICK KY
41055-8930
US

IV. Provider business mailing address

5330 LAYTHAM PIKE
MAYSLICK KY
41055-8930
US

V. Phone/Fax

Practice location:
  • Phone: 606-763-6255
  • Fax: 800-584-1465
Mailing address:
  • Phone: 606-763-6255
  • Fax: 800-584-1465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAO 2420
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: