Provider Demographics
NPI:1124012497
Name:HEBERT, LAUREN (PT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:HEBERT
Suffix:
Gender:M
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:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:DIXFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04224-0220
Mailing Address - Country:US
Mailing Address - Phone:207-562-8048
Mailing Address - Fax:207-562-7179
Practice Address - Street 1:60 WELD ST
Practice Address - Street 2:
Practice Address - City:DIXFIELD
Practice Address - State:ME
Practice Address - Zip Code:04224-9515
Practice Address - Country:US
Practice Address - Phone:207-562-8048
Practice Address - Fax:207-562-7179
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT314225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEHEALTHCAREOtherHEALTHSOURCE PROV #
ME2022587OtherAETNA PROV #
ME779004OtherTUFTS
ME010562OtherBC/BS INDIVIDUAL #
ME2022587OtherAETNA PROV #