Provider Demographics
NPI:1245264803
Name:NUTTLE, LAUREN KIMBERLY (DPT)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:KIMBERLY
Last Name:NUTTLE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 EAST OF THE SUN
Mailing Address - Street 2:165 RTE 54 #423
Mailing Address - City:FENWICK ISLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19944
Mailing Address - Country:US
Mailing Address - Phone:302-539-0890
Mailing Address - Fax:
Practice Address - Street 1:232 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:DE
Practice Address - Zip Code:19967-6728
Practice Address - Country:US
Practice Address - Phone:302-539-3110
Practice Address - Fax:302-539-7237
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002035225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist