Provider Demographics
NPI:1689398596
Name:DOYLE, LAUREN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:DOYLE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12052 JOHN HANCOCK CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-1610
Mailing Address - Country:US
Mailing Address - Phone:571-334-7825
Mailing Address - Fax:
Practice Address - Street 1:12052 JOHN HANCOCK CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-1610
Practice Address - Country:US
Practice Address - Phone:571-334-7825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019014087225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist