Healthcare Provider Details

I. General information

NPI: 1245639897
Provider Name (Legal Business Name): LAUREN BLAGG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2014
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 E COURT ST FL 4
SIDNEY OH
45365-3021
US

IV. Provider business mailing address

201 MONTEREY DR
FORT LORAMIE OH
45845-9311
US

V. Phone/Fax

Practice location:
  • Phone: 937-498-1354
  • Fax:
Mailing address:
  • Phone: 937-498-1354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number.08685
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: