Provider Demographics
NPI:1477799542
Name:PARKER, LAUREN BLAKE (PT)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:BLAKE
Last Name:PARKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1021
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-3021
Mailing Address - Country:US
Mailing Address - Phone:406-671-6343
Mailing Address - Fax:253-999-5966
Practice Address - Street 1:11515 BURNHAM DR
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-8543
Practice Address - Country:US
Practice Address - Phone:406-671-6343
Practice Address - Fax:253-999-5966
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-19
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60582289225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPT60582289OtherWASHINGTON PHYSICAL THERAPY LICENSE