Provider Demographics
NPI:1184840316
Name:ROSENBERG, LAUREN G (LMT,CKTP,CIMT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:G
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:LMT,CKTP,CIMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1679 NE GOOSEBERRY ST
Mailing Address - Street 2:
Mailing Address - City:LEE
Mailing Address - State:FL
Mailing Address - Zip Code:32059-4464
Mailing Address - Country:US
Mailing Address - Phone:727-282-7148
Mailing Address - Fax:
Practice Address - Street 1:1679 NE GOOSEBERRY ST
Practice Address - Street 2:
Practice Address - City:LEE
Practice Address - State:FL
Practice Address - Zip Code:32059-4464
Practice Address - Country:US
Practice Address - Phone:727-282-7148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2016-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA48808225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist