Provider Demographics
NPI:1659472553
Name:ALLEN, LAUREN KONITZER (PT)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:KONITZER
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:LEIGH
Other - Last Name:KONITZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:1400 OAK FOREST DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-3408
Mailing Address - Country:US
Mailing Address - Phone:954-778-6397
Mailing Address - Fax:
Practice Address - Street 1:1400 OAK FOREST DR
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-3408
Practice Address - Country:US
Practice Address - Phone:954-778-6397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL180872251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL885079800Medicaid