Basic Information
| Provider Information | |||||||||
| NPI: | 1649759432 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MISENKO | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5963 KENTSHIRE DR STE B | ||||||||
| Address2: | |||||||||
| City: | KETTERING | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454404253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9378138052 | ||||||||
| FaxNumber: | 9378138056 | ||||||||
| Practice Location | |||||||||
| Address1: | 1010 WOODMAN DR STE 110 | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454321429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9378137575 | ||||||||
| FaxNumber: | 9378138497 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2018 | ||||||||
| LastUpdateDate: | 08/13/2018 | ||||||||
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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 | PT017674 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.