Provider Demographics
NPI:1871290197
Name:SEGREST, LAUREN ALYSABETH (LPTA)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ALYSABETH
Last Name:SEGREST
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 MYRICK RD
Mailing Address - Street 2:
Mailing Address - City:DEATSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36022-3170
Mailing Address - Country:US
Mailing Address - Phone:334-315-3337
Mailing Address - Fax:
Practice Address - Street 1:7112 UNIVERSITY CT
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-8045
Practice Address - Country:US
Practice Address - Phone:334-612-7176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA11184225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant