Healthcare Provider Details

I. General information

NPI: 1336734102
Provider Name (Legal Business Name): LAUREN LUCCI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 W SPROUL RD
SPRINGFIELD PA
19064-2027
US

IV. Provider business mailing address

356 CASHEL CT
ASTON PA
19014-1247
US

V. Phone/Fax

Practice location:
  • Phone: 610-328-8800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTEI005824
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: