Provider Demographics
NPI:1841662590
Name:MOORE, LAUREN MICHELLE (LPTA)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:MICHELLE
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5718 BEACH DRIVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32408
Mailing Address - Country:US
Mailing Address - Phone:850-481-3765
Mailing Address - Fax:
Practice Address - Street 1:5718 BEACH DRIVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32408
Practice Address - Country:US
Practice Address - Phone:850-481-3765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 25821225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant