Basic Information
| Provider Information | |||||||||
| NPI: | 1093918229 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | PTA | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | CROUNSE | ||||||||
| OtherFirstName: | LAUREN | ||||||||
| OtherMiddleName: | A | ||||||||
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| OtherCredential: | PTA | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 271 W WINDSOR DR | ||||||||
| Address2: | |||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852338365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805070044 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7540 N 19TH AVE | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850217967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888734221 | ||||||||
| FaxNumber: | 8885432289 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 0226A | AZ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.