Provider Demographics
NPI:1790125847
Name:DERBY, LAUREN (DPT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:DERBY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:MALACHOWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:901 SIR FRANCIS DRAKE BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:KENTFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1502
Mailing Address - Country:US
Mailing Address - Phone:415-237-4448
Mailing Address - Fax:415-805-2648
Practice Address - Street 1:901 SIR FRANCIS DRAKE BLVD
Practice Address - Street 2:STE B
Practice Address - City:KENTFIELD
Practice Address - State:CA
Practice Address - Zip Code:94904-1502
Practice Address - Country:US
Practice Address - Phone:415-237-4448
Practice Address - Fax:415-805-2648
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39943225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist