Provider Demographics
NPI:1871077669
Name:ESTRIDGE, LAUREN MICHEL (MS, ATC, LAT)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:MICHEL
Last Name:ESTRIDGE
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 S BYRD AVE
Mailing Address - Street 2:
Mailing Address - City:SHEPHERD
Mailing Address - State:TX
Mailing Address - Zip Code:77371-3582
Mailing Address - Country:US
Mailing Address - Phone:936-628-3371
Mailing Address - Fax:936-628-6986
Practice Address - Street 1:1401 S BYRD AVE
Practice Address - Street 2:
Practice Address - City:SHEPHERD
Practice Address - State:TX
Practice Address - Zip Code:77371-3582
Practice Address - Country:US
Practice Address - Phone:936-628-3371
Practice Address - Fax:936-628-6986
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT56962255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer