Healthcare Provider Details

I. General information

NPI: 1275771081
Provider Name (Legal Business Name): LAUREN SCHNEIDER DEGORY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2009
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4824 MCMAHON BLVD NW STE 101
ALBUQUERQUE NM
87114-5412
US

IV. Provider business mailing address

4824 MCMAHON BLVD NW STE 101
ALBUQUERQUE NM
87114-5412
US

V. Phone/Fax

Practice location:
  • Phone: 505-897-3575
  • Fax: 505-897-3726
Mailing address:
  • Phone: 505-897-3575
  • Fax: 505-897-3726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3637
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: