1346417649 NPI number — DR. LAUREN CLAIRE REA DPT

Table of content: DR. LAUREN CLAIRE REA DPT (NPI 1346417649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346417649 NPI number — DR. LAUREN CLAIRE REA DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REA
Provider First Name:
LAUREN
Provider Middle Name:
CLAIRE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REYNOLDS
Provider Other First Name:
LAUREN
Provider Other Middle Name:
CLAIRE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1346417649
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2034 FOREST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAUWATOSA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53213-1670
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-774-7154
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1126 S 70TH ST STE S305B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST ALLIS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53214-3151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-456-2333
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/15/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  9738024 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)