Provider Demographics
NPI:1649838939
Name:LUTTRELL, LAUREN (DPT)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:LUTTRELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 S MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:LINDALE
Mailing Address - State:TX
Mailing Address - Zip Code:75771-7854
Mailing Address - Country:US
Mailing Address - Phone:903-780-3305
Mailing Address - Fax:903-881-6010
Practice Address - Street 1:2808 S MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771-7854
Practice Address - Country:US
Practice Address - Phone:903-780-3305
Practice Address - Fax:903-881-6010
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1363145225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist