Healthcare Provider Details

I. General information

NPI: 1871366500
Provider Name (Legal Business Name): LAUREN TABBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2023
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 E CHERRY ST
VERMILLION SD
57069-1403
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 605-741-0003
  • Fax: 605-202-6414
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP061456T
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number120948
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: