Provider Demographics
NPI:1598493652
Name:GILMORE, LAUREN JANE
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:JANE
Last Name:GILMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 STEINER RANCH BLVD APT 507
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78732-2308
Mailing Address - Country:US
Mailing Address - Phone:321-591-1001
Mailing Address - Fax:
Practice Address - Street 1:4500 STEINER RANCH BLVD APT 507
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78732-2308
Practice Address - Country:US
Practice Address - Phone:321-591-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT136995225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist