Provider Demographics
NPI:1750751723
Name:WADSWORTH, LAUREN R (LMT)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:R
Last Name:WADSWORTH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-1339
Mailing Address - Country:US
Mailing Address - Phone:304-667-2195
Mailing Address - Fax:
Practice Address - Street 1:120 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-1339
Practice Address - Country:US
Practice Address - Phone:304-667-2195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1998-0127225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist