Basic Information
| Provider Information | |||||||||
| NPI: | 1619334984 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DENGLER | ||||||||
| FirstName: | LAUREN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 818 PENN AVENUE | ||||||||
| Address2: | |||||||||
| City: | DREXEL HILL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109556480 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 EVERGREEN DR | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | GLEN MILLS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193421059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105793650 | ||||||||
| FaxNumber: | 6105793655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2016 | ||||||||
| LastUpdateDate: | 08/17/2017 | ||||||||
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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 | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.