Provider Demographics
NPI:1346417649
Name:REA, LAUREN CLAIRE (DPT)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:CLAIRE
Last Name:REA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:LAUREN
Other - Middle Name:CLAIRE
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2034 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-1670
Mailing Address - Country:US
Mailing Address - Phone:414-774-7154
Mailing Address - Fax:
Practice Address - Street 1:1126 S 70TH ST STE S305B
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-3151
Practice Address - Country:US
Practice Address - Phone:414-456-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9738024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist