Provider Demographics
NPI:1578857181
Name:PETREE, LAUREN ASHLEY (PTA)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:ASHLEY
Last Name:PETREE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 NW COUNTY ROAD 2110
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-8906
Mailing Address - Country:US
Mailing Address - Phone:972-921-5718
Mailing Address - Fax:
Practice Address - Street 1:2460 N I 35 STE 260
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-5278
Practice Address - Country:US
Practice Address - Phone:972-938-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2058970225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant