Provider Demographics
NPI:1265581870
Name:MACGUIRE BOLLING, LAUREN ELIZABETH (DPT)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:ELIZABETH
Last Name:MACGUIRE BOLLING
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:LAUREN
Other - Middle Name:ELIZABETH
Other - Last Name:MACGUIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2623 BROOKE WILLOW BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-1894
Mailing Address - Country:US
Mailing Address - Phone:865-335-3035
Mailing Address - Fax:
Practice Address - Street 1:2623 BROOKE WILLOW BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932-1894
Practice Address - Country:US
Practice Address - Phone:865-335-3035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6003225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3653311Medicaid
TNCH4394OtherMEDICARE-RAILROAD GROUP ID
TN4144774OtherBLUECROSS BLUESHIELD TN
TNCH4394OtherMEDICARE-RAILROAD GROUP ID