Provider Demographics
NPI:1093348229
Name:YBARRONDO, LAUREN M (PTA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:M
Last Name:YBARRONDO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2245 CRESTED WHEAT LOOP
Mailing Address - Street 2:
Mailing Address - City:EAST HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59635-9434
Mailing Address - Country:US
Mailing Address - Phone:216-408-6388
Mailing Address - Fax:
Practice Address - Street 1:330 11TH AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3740
Practice Address - Country:US
Practice Address - Phone:406-441-4445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT14908225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant