Provider Demographics
NPI:1225201700
Name:BARRIS, LAUREN DORICE (PT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:DORICE
Last Name:BARRIS
Suffix:
Gender:F
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 95
Mailing Address - Street 2:
Mailing Address - City:SAGAPONACK
Mailing Address - State:NY
Mailing Address - Zip Code:11962
Mailing Address - Country:US
Mailing Address - Phone:516-680-3172
Mailing Address - Fax:
Practice Address - Street 1:73 SCOTLINE DRIVE
Practice Address - Street 2:
Practice Address - City:SAGAPONACK
Practice Address - State:NY
Practice Address - Zip Code:11962-0095
Practice Address - Country:US
Practice Address - Phone:516-680-3172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017374225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQL8131Medicare PIN