Provider Demographics
NPI:1740651538
Name:TERPAK, LAUREN
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:TERPAK
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 1:16 VIRBITSKY RD
Mailing Address - Street 2:
Mailing Address - City:SCOTT TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18433-7909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16 VIRBITSKY RD
Practice Address - Street 2:
Practice Address - City:SCOTT TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18433-7909
Practice Address - Country:US
Practice Address - Phone:570-267-7745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2016-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003249-12255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program