Provider Demographics
NPI:1689909814
Name:GILLEY, LAUREN MICHELLE (PT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MICHELLE
Last Name:GILLEY
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 1:2751 OVARSITY WAY
Mailing Address - Street 2:SUITE 265
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45221-0001
Mailing Address - Country:US
Mailing Address - Phone:513-556-3178
Mailing Address - Fax:513-556-6506
Practice Address - Street 1:2751 OVARSITY WAY
Practice Address - Street 2:SUITE 265
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45221-0001
Practice Address - Country:US
Practice Address - Phone:513-556-3178
Practice Address - Fax:513-556-6506
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.012658225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist