Provider Demographics
NPI:1043890130
Name:MCINTOSH, LAUREN
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MOTT
Mailing Address - State:ND
Mailing Address - Zip Code:58646-7563
Mailing Address - Country:US
Mailing Address - Phone:218-230-0799
Mailing Address - Fax:
Practice Address - Street 1:401 MILLIONAIRE AVE
Practice Address - Street 2:
Practice Address - City:MOTT
Practice Address - State:ND
Practice Address - Zip Code:58646-7270
Practice Address - Country:US
Practice Address - Phone:701-824-3222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics