Provider Demographics
NPI:1407311061
Name:STAUFFER, LAUREN (PT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:STAUFFER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:MALICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1 LEGEND LANE
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-9424
Mailing Address - Country:US
Mailing Address - Phone:717-620-7100
Mailing Address - Fax:717-620-7102
Practice Address - Street 1:1 LEGEND LANE
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-9424
Practice Address - Country:US
Practice Address - Phone:717-620-7100
Practice Address - Fax:717-620-7102
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT027502225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist