Provider Demographics
NPI:1447664941
Name:JOHNSON, LAUREN
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:JOHNSON
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 1:45 S WASHINGTON ST
Mailing Address - Street 2:APT 301
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-2058
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:45 S WASHINGTON ST
Practice Address - Street 2:APT 301
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-2058
Practice Address - Country:US
Practice Address - Phone:847-858-8311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013127225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant