Basic Information
| Provider Information | |||||||||
| NPI: | 1245264803 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NUTTLE | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | KIMBERLY | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | D.P.T | ||||||||
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| Mailing Information | |||||||||
| Address1: | 423 EAST OF THE SUN | ||||||||
| Address2: | 165 RTE 54 #423 | ||||||||
| City: | FENWICK ISLAND | ||||||||
| State: | DE | ||||||||
| PostalCode: | 19944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3025390890 | ||||||||
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| Practice Location | |||||||||
| Address1: | 232 ATLANTIC AVE | ||||||||
| Address2: | |||||||||
| City: | MILLVILLE | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199676728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3025393110 | ||||||||
| FaxNumber: | 3025397237 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 07/07/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | J1-0002035 | DE | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.