Provider Demographics
NPI:1265973713
Name:LAUREN LOBERT PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:LAUREN LOBERT PHYSICAL THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:FRANCINE
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-534-7004
Mailing Address - Street 1:603 W GRAND RIVER AVE STE C
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-2390
Mailing Address - Country:US
Mailing Address - Phone:810-534-7004
Mailing Address - Fax:810-534-7004
Practice Address - Street 1:603 W GRAND RIVER AVE STE C
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2390
Practice Address - Country:US
Practice Address - Phone:810-534-7004
Practice Address - Fax:810-775-1046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016080225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty