Healthcare Provider Details

I. General information

NPI: 1225973399
Provider Name (Legal Business Name): LAUREN SPEARS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 SUMMIT CROSSING PL
GASTONIA NC
28054-2192
US

IV. Provider business mailing address

1811 ALLEGHENY DR
GASTONIA NC
28054-3539
US

V. Phone/Fax

Practice location:
  • Phone: 704-671-1860
  • Fax:
Mailing address:
  • Phone: 828-748-4438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA6887
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: