Provider Demographics
NPI:1518249903
Name:CARNES, LAUREN ELIZABETH (MPT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ELIZABETH
Last Name:CARNES
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:90 E MAIN ST # A
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-3030
Mailing Address - Country:US
Mailing Address - Phone:828-550-3923
Mailing Address - Fax:828-354-0209
Practice Address - Street 1:80 SONGBIRD FOREST RD
Practice Address - Street 2:
Practice Address - City:BRYSON CITY
Practice Address - State:NC
Practice Address - Zip Code:28713-0929
Practice Address - Country:US
Practice Address - Phone:828-488-0040
Practice Address - Fax:828-354-0209
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP15715225100000X
WV002982225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV516524Medicare Oscar/Certification