Provider Demographics
NPI:1649597642
Name:LAUSEN, KRISTA LANE (PT)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:LANE
Last Name:LAUSEN
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 1:164 W HART ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:WY
Mailing Address - Zip Code:82834-1738
Mailing Address - Country:US
Mailing Address - Phone:307-684-8623
Mailing Address - Fax:307-684-8623
Practice Address - Street 1:509 FORT ST STE B
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:WY
Practice Address - Zip Code:82834-1867
Practice Address - Country:US
Practice Address - Phone:307-684-8623
Practice Address - Fax:307-684-8623
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-0676225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist