Provider Demographics
NPI:1083918718
Name:GRAWE, LAUREN (DPT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:GRAWE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:CHETNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10570 BERGTOLD ROAD
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:NY
Mailing Address - Zip Code:14031
Mailing Address - Country:US
Mailing Address - Phone:716-759-7680
Mailing Address - Fax:716-759-0197
Practice Address - Street 1:10570 BERGTOLD ROAD
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:NY
Practice Address - Zip Code:14031
Practice Address - Country:US
Practice Address - Phone:716-759-7680
Practice Address - Fax:716-759-0197
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6321225100000X
VA2305206729225100000X
NCP12898225100000X
NY033158225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist