Provider Demographics
NPI:1417044405
Name:ROCCONI, LAUREN KRISTEN (PT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:KRISTEN
Last Name:ROCCONI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:KRISTEN
Other - Last Name:WOOTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 770929
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38177-0929
Mailing Address - Country:US
Mailing Address - Phone:901-850-5756
Mailing Address - Fax:901-850-5911
Practice Address - Street 1:9950 CROOKED CREEK DRIVE
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017
Practice Address - Country:US
Practice Address - Phone:901-850-5756
Practice Address - Fax:901-850-5911
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7115225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7115OtherPT LICENSE