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General NPI Number Information
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NPI Number | 1184175853
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Entity Type | Individual
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Provider Name | LAUREN MORITZ PTA
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Gender | Female
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Dates
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Enumeration Date | 10/18/2016
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Last Update Date | 10/18/2016
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Provider Practice Location Address
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Address Line | 1101 STROUD AVE
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City | KINGSBURG
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State | CA
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Zip | 93631-1016
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Country | US
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Telephone | 559-897-5881
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Fax |
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Provider Business Mailing Address
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Address Line | 2517 24TH AVE
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City | KINGSBURG
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State | CA
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Zip | 93631-1222
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Country | US
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Telephone | 559-801-6777
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 48159
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License Number State | CA
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