Basic Information
| Provider Information | |||||||||
| NPI: | 1508385584 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RANDALL | ||||||||
| FirstName: | LAUREN | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 TARRAGON DR | ||||||||
| Address2: | |||||||||
| City: | EAST HAMPTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064241757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609167870 | ||||||||
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| Practice Location | |||||||||
| Address1: | 97 BARNES RD | ||||||||
| Address2: | |||||||||
| City: | WALLINGFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064921885 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037937592 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2017 | ||||||||
| LastUpdateDate: | 08/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 13215 | CT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.