Healthcare Provider Details

I. General information

NPI: 1760146567
Provider Name (Legal Business Name): LAUREN DOMENICA STOLLMAN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13937 S SPRAGUE LN STE 100
DRAPER UT
84020-7864
US

IV. Provider business mailing address

13937 S SPRAGUE LN STE 100
DRAPER UT
84020-7864
US

V. Phone/Fax

Practice location:
  • Phone: 385-308-8034
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1106906
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number054153-01
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT033713
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL18521
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2021033723
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number309061
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: