Provider Demographics
NPI:1225735822
Name:MATHOT, LAUREN E (PT, DPT, CBIS)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:E
Last Name:MATHOT
Suffix:
Gender:F
Credentials:PT, DPT, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 GRAND CYPRESS BLVD
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45068-9805
Mailing Address - Country:US
Mailing Address - Phone:216-534-8201
Mailing Address - Fax:
Practice Address - Street 1:1816 GRAND CYPRESS BLVD
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:OH
Practice Address - Zip Code:45068-9805
Practice Address - Country:US
Practice Address - Phone:216-534-8201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT011828225100000X, 2251N0400X, 2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology