Provider Demographics
NPI:1811208135
Name:WEDAM, LAUREN M (DPT)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:M
Last Name:WEDAM
Suffix:
Gender:F
Credentials:DPT
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 64823
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05406-4823
Mailing Address - Country:US
Mailing Address - Phone:802-318-0581
Mailing Address - Fax:802-448-5951
Practice Address - Street 1:1233 SHELBURNE RD STE 470
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7780
Practice Address - Country:US
Practice Address - Phone:802-318-0581
Practice Address - Fax:508-448-5951
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0066530225100000X, 2251G0304X
MA201552251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT040.0066530OtherLICENSURE NUMBER