Provider Demographics
NPI:1649738436
Name:WALLER, LAUREN KATHLEEN (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:KATHLEEN
Last Name:WALLER
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 1:2817 W END AVE STE 126-108
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1453
Mailing Address - Country:US
Mailing Address - Phone:615-557-8204
Mailing Address - Fax:
Practice Address - Street 1:4825 TROUSDALE DR STE 216
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37220-1307
Practice Address - Country:US
Practice Address - Phone:615-781-1005
Practice Address - Fax:615-781-1009
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11477225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist