Provider Demographics
NPI:1649759432
Name:MISENKO, LAUREN R (DPT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:R
Last Name:MISENKO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5963 KENTSHIRE DR STE B
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45440-4253
Mailing Address - Country:US
Mailing Address - Phone:937-813-8052
Mailing Address - Fax:937-813-8056
Practice Address - Street 1:1010 WOODMAN DR STE 110
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45432-1429
Practice Address - Country:US
Practice Address - Phone:937-813-7575
Practice Address - Fax:937-813-8497
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT017674225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist