1760777601 NPI number — LAUREN LEHMAN DPT

Table of content: LAUREN LEHMAN DPT (NPI 1760777601)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760777601 NPI number — LAUREN LEHMAN DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEHMAN
Provider First Name:
LAUREN
Provider Middle Name:
Provider Name Prefix Text:
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760777601
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4113-C NW 6TH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32609-0731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-376-6300
Provider Business Mailing Address Fax Number:
352-372-0661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4113-C NW 6TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32609-0731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-376-6300
Provider Business Practice Location Address Fax Number:
352-372-0661
Provider Enumeration Date:
06/17/2011

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:  PT27274 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Y0C17 . This is a "FLORIDA BLUE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: GF863W . This is a "MEDICARE PTAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".