Provider Demographics
NPI:1871944140
Name:CARLSON, LAUREN RING (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:RING
Last Name:CARLSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ELIZABETH
Other - Last Name:RING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:620 HALTON RD
Mailing Address - Street 2:APT #14305
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3440
Mailing Address - Country:US
Mailing Address - Phone:678-777-8632
Mailing Address - Fax:
Practice Address - Street 1:2005 E GREENVILLE ST
Practice Address - Street 2:SUITE 119
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1575
Practice Address - Country:US
Practice Address - Phone:864-964-0505
Practice Address - Fax:864-222-0182
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC.8243 PT225100000X
GAPT012354225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist