=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992424170
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAUREN R POWELL PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2022
-----------------------------------------------------
Last Update Date | 09/29/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 880 CORPORATE DR STE 202
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40503-5449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-797-5513
-----------------------------------------------------
Fax | 859-898-0538
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 911063
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40591-1063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-797-5513
-----------------------------------------------------
Fax | 859-898-0538
-----------------------------------------------------
=====================================================
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 | 14368
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT-008904
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------