Healthcare Provider Details

I. General information

NPI: 1780221655
Provider Name (Legal Business Name): LAUREN FIUST-KLINK PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date: 04/14/2024
Reactivation Date: 05/21/2024

III. Provider practice location address

PO BOX 394
EAST AURORA NY
14052-0394
US

IV. Provider business mailing address

PO BOX 394
EAST AURORA NY
14052-0394
US

V. Phone/Fax

Practice location:
  • Phone: 716-222-9139
  • Fax:
Mailing address:
  • Phone: 716-222-9139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number043657
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number043657
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: