Provider Demographics
NPI:1437423795
Name:EVERETTS, LAUREN
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:EVERETTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1684 BUCK HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:BIG COVE TANNERY
Mailing Address - State:PA
Mailing Address - Zip Code:17212-9580
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1684 BUCK HOLLOW RD
Practice Address - Street 2:
Practice Address - City:BIG COVE TANNERY
Practice Address - State:PA
Practice Address - Zip Code:17212-9580
Practice Address - Country:US
Practice Address - Phone:717-300-0268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT021634225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist