=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396091419
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAUREN DEUELL DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2012
-----------------------------------------------------
Last Update Date | 04/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3791 OLD CANOE CREEK RD
-----------------------------------------------------
City | SAINT CLOUD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34769-6630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-946-5685
-----------------------------------------------------
Fax | 914-946-0304
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1536 3RD AVE 5TH FL
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10028-2167
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-861-2630
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT31229
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------