Provider Demographics
NPI:1376891465
Name:SANDERS, LAUREN (ATC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 E WORTHY ST
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-4241
Mailing Address - Country:US
Mailing Address - Phone:225-391-6100
Mailing Address - Fax:
Practice Address - Street 1:612 E WORTHY ST
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4241
Practice Address - Country:US
Practice Address - Phone:225-391-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAATH.2001032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAATH.200103OtherLOUISIANA STATE BOARD OF MEDICAL EXAMINERS