Provider Demographics
NPI:1134474273
Name:VAN DER SLUYS, LAUREN GROVES (PT)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:GROVES
Last Name:VAN DER SLUYS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:DAVIS
Other - Last Name:GROVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4045 JOHNS CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1217
Mailing Address - Country:US
Mailing Address - Phone:678-206-6061
Mailing Address - Fax:678-206-6064
Practice Address - Street 1:4045 JOHNS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1217
Practice Address - Country:US
Practice Address - Phone:678-206-6061
Practice Address - Fax:678-206-6064
Is Sole Proprietor?:No
Enumeration Date:2012-07-15
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist