Provider Demographics
NPI:1467834986
Name:SURDYKE, LAUREN (DPT)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:
Last Name:SURDYKE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1588 RIVERTRACE DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32003-7777
Mailing Address - Country:US
Mailing Address - Phone:904-710-5044
Mailing Address - Fax:
Practice Address - Street 1:14286 BEACH BLVD STE 34
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250-1570
Practice Address - Country:US
Practice Address - Phone:904-345-7510
Practice Address - Fax:904-345-7540
Is Sole Proprietor?:No
Enumeration Date:2015-06-20
Last Update Date:2015-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30389225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist