Healthcare Provider Details

I. General information

NPI: 1548936149
Provider Name (Legal Business Name): LAUREN ANDERSON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 NEW HARTFORD RD STE C
OWENSBORO KY
42303-1384
US

IV. Provider business mailing address

2841 NEW HARTFORD RD
OWENSBORO KY
42303-1320
US

V. Phone/Fax

Practice location:
  • Phone: 270-240-2246
  • Fax: 270-926-2364
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number008341
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: