Provider Demographics
NPI:1811663503
Name:THOMAS, LAUREN LEE
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:LEE
Last Name:THOMAS
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 1:7314 STINSON AVE APT A8
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1171
Mailing Address - Country:US
Mailing Address - Phone:678-863-2915
Mailing Address - Fax:
Practice Address - Street 1:1649 E 72ND ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98404-5402
Practice Address - Country:US
Practice Address - Phone:253-472-9027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-21
Last Update Date:2021-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA004060225200000X
CAPTA49900225200000X
WACP007459A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant