Provider Demographics
NPI:1992204267
Name:BENNETT, LAUREN NICOLE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:NICOLE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:NICOLE
Other - Last Name:VENHAUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2527 BLACKFOREST DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-4703
Mailing Address - Country:US
Mailing Address - Phone:636-633-6670
Mailing Address - Fax:
Practice Address - Street 1:2018 LONG GATE CT
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-7415
Practice Address - Country:US
Practice Address - Phone:636-893-8312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018003475225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist