Provider Demographics
NPI:1891322616
Name:GASS, LAUREN BLAKEY (LAT, ATC, CSCS)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:BLAKEY
Last Name:GASS
Suffix:
Gender:F
Credentials:LAT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7320 BRICE KNOLL LN APT D-305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-3435
Mailing Address - Country:US
Mailing Address - Phone:704-941-1803
Mailing Address - Fax:
Practice Address - Street 1:7320 BRICE KNOLL LN # D-305
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-3435
Practice Address - Country:US
Practice Address - Phone:704-941-1803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2255A2300X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer