Provider Demographics
NPI:1659407526
Name:FACEMYER, LAUREN KOPELOVE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:KOPELOVE
Last Name:FACEMYER
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 1:371 STONEHURST PKWY
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-5017
Mailing Address - Country:US
Mailing Address - Phone:904-347-4534
Mailing Address - Fax:
Practice Address - Street 1:1205 MONUMENT RD
Practice Address - Street 2:SUITE 202
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-7406
Practice Address - Country:US
Practice Address - Phone:904-725-9994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23092225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist