Provider Demographics
NPI:1114535580
Name:TALLEY, LAUREN ELISABETH (DPT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ELISABETH
Last Name:TALLEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 METAIRIE LAWN DR
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-6107
Mailing Address - Country:US
Mailing Address - Phone:504-841-0150
Mailing Address - Fax:504-841-0180
Practice Address - Street 1:2620 METAIRIE LAWN DR
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-6107
Practice Address - Country:US
Practice Address - Phone:504-841-0150
Practice Address - Fax:504-841-0180
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10601225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA10601OtherPROVISIONAL LICENSE