Provider Demographics
NPI:1639671621
Name:SIRACUSA, LAUREN ANTONETTE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ANTONETTE
Last Name:SIRACUSA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 E 1ST AVE STE 307
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-2454
Mailing Address - Country:US
Mailing Address - Phone:303-466-6463
Mailing Address - Fax:
Practice Address - Street 1:340 E 1ST AVE STE 307
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-2454
Practice Address - Country:US
Practice Address - Phone:303-466-6463
Practice Address - Fax:303-466-1250
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2020-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0016989225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist