Provider Demographics
NPI:1063638278
Name:KOHLER, LAUREN GRACE (PT)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:GRACE
Last Name:KOHLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PLEASANT AVE
Mailing Address - Street 2:#2
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-1815
Mailing Address - Country:US
Mailing Address - Phone:410-206-0482
Mailing Address - Fax:
Practice Address - Street 1:187 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-1515
Practice Address - Country:US
Practice Address - Phone:617-776-4776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17563225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist