Provider Demographics
NPI:1750063947
Name:ANDERSON, LAURYN ELIZABETH (PTA)
Entity type:Individual
Prefix:
First Name:LAURYN
Middle Name:ELIZABETH
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6112 LITTLE FOXES RUN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5638
Mailing Address - Country:US
Mailing Address - Phone:410-707-7538
Mailing Address - Fax:
Practice Address - Street 1:9256 BENDIX RD # 105-106
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-1840
Practice Address - Country:US
Practice Address - Phone:410-707-7538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA5836225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant