Provider Demographics
NPI:1902363369
Name:PICKERING, LAUREN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:PICKERING
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N FULTON ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830-3020
Mailing Address - Country:US
Mailing Address - Phone:479-979-7690
Mailing Address - Fax:
Practice Address - Street 1:513 COUNTY ROAD 2750
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:AR
Practice Address - Zip Code:72847-8302
Practice Address - Country:US
Practice Address - Phone:479-979-7690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4569225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist