Provider Demographics
NPI:1235205642
Name:FISK, LAUREN M (PT, MSPT)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:M
Last Name:FISK
Suffix:
Gender:F
Credentials:PT, MSPT
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:E
Other - Last Name:MAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, MSPT
Mailing Address - Street 1:235 E WARNER RD
Mailing Address - Street 2:STE B104
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-2972
Mailing Address - Country:US
Mailing Address - Phone:480-633-3151
Mailing Address - Fax:480-383-6076
Practice Address - Street 1:235 E WARNER RD
Practice Address - Street 2:SUITE B104
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-2972
Practice Address - Country:US
Practice Address - Phone:480-633-3151
Practice Address - Fax:480-383-6076
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6279225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist