Provider Demographics
NPI:1992181762
Name:FOURNIER, LAUREN M (PT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:M
Last Name:FOURNIER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:J
Other - Last Name:MARUCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:207 MEETINGHOUSE RD.
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110
Mailing Address - Country:US
Mailing Address - Phone:603-644-8334
Mailing Address - Fax:603-644-8339
Practice Address - Street 1:207 MEETINGHOUSE RD.
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110
Practice Address - Country:US
Practice Address - Phone:603-644-8334
Practice Address - Fax:603-644-8339
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21909225100000X
NH4381225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist