Provider Demographics
NPI:1912547134
Name:ASHBURN, LAUREN MICHELE (PTA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MICHELE
Last Name:ASHBURN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14705 CRYSTAL LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-2765
Mailing Address - Country:US
Mailing Address - Phone:214-797-7867
Mailing Address - Fax:
Practice Address - Street 1:480 BRAY CENTRAL DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6418
Practice Address - Country:US
Practice Address - Phone:972-330-4397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2098896225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant