Provider Demographics
NPI:1255948626
Name:BAULCH, LAUREN MICHELLE (DPT)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MICHELLE
Last Name:BAULCH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:MICHELLE
Other - Last Name:NITOSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11910 ARBOR DOWNS RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-2039
Mailing Address - Country:US
Mailing Address - Phone:904-347-4724
Mailing Address - Fax:
Practice Address - Street 1:11215 S INTERSTATE 35 STE 102
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78747-1864
Practice Address - Country:US
Practice Address - Phone:512-292-1908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1166730225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist