Provider Demographics
NPI:1245671221
Name:BRETIENBACH, LAUREN MICHELLE
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:MICHELLE
Last Name:BRETIENBACH
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 1:132 RANDALL DR
Mailing Address - Street 2:
Mailing Address - City:PIKETON
Mailing Address - State:OH
Mailing Address - Zip Code:45661-8133
Mailing Address - Country:US
Mailing Address - Phone:740-222-1192
Mailing Address - Fax:
Practice Address - Street 1:132 RANDALL DR
Practice Address - Street 2:
Practice Address - City:PIKETON
Practice Address - State:OH
Practice Address - Zip Code:45661-8133
Practice Address - Country:US
Practice Address - Phone:740-222-1192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0040962255A2300X
NHCP024527A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer