Provider Demographics
NPI:1700358900
Name:MORRA, LAUREN MARIE
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MARIE
Last Name:MORRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 HIBRITEN WAY
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-2228
Mailing Address - Country:US
Mailing Address - Phone:863-669-8142
Mailing Address - Fax:
Practice Address - Street 1:404 HIBRITEN WAY
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-2228
Practice Address - Country:US
Practice Address - Phone:863-669-8142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
294823225100000X
CA294823225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist