Provider Demographics
NPI:1598535544
Name:DONOVAN, LAUREN (PT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:DONOVAN
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 1:1218 CURTIS AVE
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-3516
Mailing Address - Country:US
Mailing Address - Phone:914-224-9382
Mailing Address - Fax:
Practice Address - Street 1:1218 CURTIS AVE
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT BEACH
Practice Address - State:NJ
Practice Address - Zip Code:08742-3516
Practice Address - Country:US
Practice Address - Phone:914-224-9382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02215000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist