Provider Demographics
NPI:1922778141
Name:COONEY, LAUREN OLIVIA (LMT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:OLIVIA
Last Name:COONEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2378 ROLLING FORK CIR APT 103
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-5176
Mailing Address - Country:US
Mailing Address - Phone:571-527-8117
Mailing Address - Fax:
Practice Address - Street 1:2378 ROLLING FORK CIR APT 103
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-5176
Practice Address - Country:US
Practice Address - Phone:571-527-8117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-18
Last Update Date:2021-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019018155225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist