Provider Demographics
NPI:1609250836
Name:SIBLEY, LAUREN B (DPT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:B
Last Name:SIBLEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:E
Other - Last Name:BLENKARN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1326 CHURCH STREE
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-2743
Mailing Address - Country:US
Mailing Address - Phone:225-654-8208
Mailing Address - Fax:225-654-4642
Practice Address - Street 1:11281 OLD HAMMOND HWY
Practice Address - Street 2:SUITE C
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816
Practice Address - Country:US
Practice Address - Phone:225-275-3177
Practice Address - Fax:225-275-0922
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2020-11-23
Deactivation Date:2020-08-03
Deactivation Code:
Reactivation Date:2020-10-07
Provider Licenses
StateLicense IDTaxonomies
LA09124R2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic