Provider Demographics
NPI:1376869909
Name:EMMEL, LAUREN (DPT)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:EMMEL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 2ND AVE N
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-2508
Mailing Address - Country:US
Mailing Address - Phone:218-233-7578
Mailing Address - Fax:218-233-8307
Practice Address - Street 1:2810 2ND AVE N
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-2508
Practice Address - Country:US
Practice Address - Phone:218-233-7578
Practice Address - Fax:218-233-8307
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8416225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist