Provider Demographics
NPI:1689817017
Name:KOELLING, LAUREN ROXANNE (PT)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:ROXANNE
Last Name:KOELLING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 291
Mailing Address - Street 2:
Mailing Address - City:ROSEBUD
Mailing Address - State:MO
Mailing Address - Zip Code:63091-0291
Mailing Address - Country:US
Mailing Address - Phone:573-694-8396
Mailing Address - Fax:
Practice Address - Street 1:314 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:MO
Practice Address - Zip Code:65453-1831
Practice Address - Country:US
Practice Address - Phone:573-667-2030
Practice Address - Fax:573-677-2033
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008036317225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist