Provider Demographics
NPI:1225552417
Name:PROENCA, LAUREN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:PROENCA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 SEABREEZE CIR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-6426
Mailing Address - Country:US
Mailing Address - Phone:561-662-5863
Mailing Address - Fax:
Practice Address - Street 1:166 SEABREEZE CIR
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-6426
Practice Address - Country:US
Practice Address - Phone:561-662-5863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT32537225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist