Provider Demographics
NPI:1417166075
Name:SCULLY, LAUREN (PT, DPT, PRPC)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:
Last Name:SCULLY
Suffix:
Gender:F
Credentials:PT, DPT, PRPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 55TH ST
Mailing Address - Street 2:LUTHERAN MEDICAL CENTER
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-2559
Mailing Address - Country:US
Mailing Address - Phone:718-630-7000
Mailing Address - Fax:
Practice Address - Street 1:9000 SHORE ROAD, EAST BUILDING, LOWER LOBBY
Practice Address - Street 2:SHORE ROAD REHABILITATION
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-5449
Practice Address - Country:US
Practice Address - Phone:718-921-2945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029153-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist