Provider Demographics
NPI:1457842155
Name:KNUTH, LAUREN LAGRO
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:LAGRO
Last Name:KNUTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:MICHELLE
Other - Last Name:LAGRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10177 STATION WAY APT 146
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-6847
Mailing Address - Country:US
Mailing Address - Phone:214-263-2778
Mailing Address - Fax:
Practice Address - Street 1:11960 LIONESS WAY STE 260
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-5640
Practice Address - Country:US
Practice Address - Phone:033-449-0903
Practice Address - Fax:720-895-1121
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTLP.0000122225100000X
COPTL.0015896225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist