Provider Demographics
NPI:1669166443
Name:POLLOCK, LAUREN O
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:O
Last Name:POLLOCK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ONEAL
Other - Last Name:GRAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4101 COX RD STE 360
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3320
Mailing Address - Country:US
Mailing Address - Phone:804-716-0457
Mailing Address - Fax:804-716-0496
Practice Address - Street 1:4101 COX RD STE 360
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3320
Practice Address - Country:US
Practice Address - Phone:804-716-0457
Practice Address - Fax:804-716-0496
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305215800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist