Provider Demographics
NPI:1083276315
Name:SMITH, LAUREN MICHELLE (DPT)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:MICHELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:MICHELLE
Other - Last Name:BRIDGEWATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:90 CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125-4042
Mailing Address - Country:US
Mailing Address - Phone:636-524-5995
Mailing Address - Fax:
Practice Address - Street 1:90 CLIFF DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-4042
Practice Address - Country:US
Practice Address - Phone:636-524-5995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12288225100000X
MO2020023324225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist