Provider Demographics
NPI:1821634064
Name:BLOUNT, LAUREN MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MARIE
Last Name:BLOUNT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:MARIE
Other - Last Name:SEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2018 MCINGVALE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-8706
Mailing Address - Country:US
Mailing Address - Phone:662-298-2276
Mailing Address - Fax:662-298-2278
Practice Address - Street 1:2018 MCINGVALE RD STE 102
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-8706
Practice Address - Country:US
Practice Address - Phone:662-298-2276
Practice Address - Fax:662-298-2278
Is Sole Proprietor?:No
Enumeration Date:2019-11-22
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT6537225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist