Provider Demographics
NPI:1518145036
Name:MCMILLAN, LAUREN WARD (PT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:WARD
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4242 LACLEDE AVE
Mailing Address - Street 2:UNIT 106
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2884
Mailing Address - Country:US
Mailing Address - Phone:314-371-1600
Mailing Address - Fax:314-371-1600
Practice Address - Street 1:55 WESTPORT PLZ
Practice Address - Street 2:SUITE 470
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-3109
Practice Address - Country:US
Practice Address - Phone:314-317-5429
Practice Address - Fax:314-514-1589
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO00909225100000X
MO2001033179225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist