Provider Demographics
NPI:1720360860
Name:BLAIR, LAUREN ELYSE (LMT)
Entity Type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:ELYSE
Last Name:BLAIR
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 1:1291 WINTER GARDEN VINELAND RD
Mailing Address - Street 2:#130
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-6705
Mailing Address - Country:US
Mailing Address - Phone:407-614-5900
Mailing Address - Fax:407-614-5903
Practice Address - Street 1:1291 WINTER GARDEN VINELAND RD
Practice Address - Street 2:#130
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-6705
Practice Address - Country:US
Practice Address - Phone:407-614-5900
Practice Address - Fax:407-614-5903
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA59939225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist