Provider Demographics
NPI:1184340366
Name:MIYAMOTO, LAUREN REI
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:REI
Last Name:MIYAMOTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:959 IRONSHOE CT
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-0909
Mailing Address - Country:US
Mailing Address - Phone:909-260-0243
Mailing Address - Fax:
Practice Address - Street 1:959 IRONSHOE CT
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-0909
Practice Address - Country:US
Practice Address - Phone:909-260-0243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic