Provider Demographics
NPI:1578986964
Name:BLASE, LAUREN MICHELLE (PT)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:MICHELLE
Last Name:BLASE
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 1:4541 E 28TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-6236
Mailing Address - Country:US
Mailing Address - Phone:330-550-9813
Mailing Address - Fax:
Practice Address - Street 1:2408 E 81ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-4200
Practice Address - Country:US
Practice Address - Phone:918-477-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4782225100000X
OHPT.014497225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist