Healthcare Provider Details

I. General information

NPI: 1750758389
Provider Name (Legal Business Name): LAUREN CARRUTHERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2015
Last Update Date: 08/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8348 TRAFORD LN SUITE 200
SPRINGFIELD VA
22152-1663
US

IV. Provider business mailing address

3900 FAIRFAX DR APT 1921
ARLINGTON VA
22203-1661
US

V. Phone/Fax

Practice location:
  • Phone: 703-569-7500
  • Fax: 703-866-0158
Mailing address:
  • Phone: 703-569-7500
  • Fax: 703-866-0158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2305209772
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: