Provider Demographics
NPI:1790940021
Name:LAFFERTY, LAUREN NELSON (PT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:NELSON
Last Name:LAFFERTY
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 1:2580 JACKSON AVE W STE 38
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5490
Mailing Address - Country:US
Mailing Address - Phone:662-232-8949
Mailing Address - Fax:662-232-8950
Practice Address - Street 1:2580 JACKSON AVE W STE 38
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5490
Practice Address - Country:US
Practice Address - Phone:662-232-8949
Practice Address - Fax:662-232-8950
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT4383225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist