Provider Demographics
NPI:1558672642
Name:SHAFER, LAUREN JOY (PT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:JOY
Last Name:SHAFER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6245 N 24TH PKWY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-2024
Mailing Address - Country:US
Mailing Address - Phone:602-997-7844
Mailing Address - Fax:602-997-8020
Practice Address - Street 1:6245 N 24TH PKWY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-2024
Practice Address - Country:US
Practice Address - Phone:602-997-7844
Practice Address - Fax:602-997-8020
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8945225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic