Provider Demographics
NPI:1609594613
Name:HOOVER, LAUREN RENEE (PT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:RENEE
Last Name:HOOVER
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 1:205 ROBERTS DR
Mailing Address - Street 2:
Mailing Address - City:SOMERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:08083-2533
Mailing Address - Country:US
Mailing Address - Phone:856-693-1600
Mailing Address - Fax:
Practice Address - Street 1:4150 INDIAN RIVER BLVD
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32967-7224
Practice Address - Country:US
Practice Address - Phone:772-778-5961
Practice Address - Fax:772-778-5962
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT39148225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist