Provider Demographics
NPI:1821405853
Name:HAINES, LAUREN TAYLOR (DPT,PT)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:TAYLOR
Last Name:HAINES
Suffix:
Gender:F
Credentials:DPT,PT
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ELISE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:919-258-2714
Mailing Address - Fax:
Practice Address - Street 1:17301 VALLEY MALL RD
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6966
Practice Address - Country:US
Practice Address - Phone:240-850-2002
Practice Address - Fax:240-850-2003
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD225100000X
WVAT00012812255A2300X
MD27683225100000X
VA2305213152225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer