Provider Demographics
NPI:1023339942
Name:WATSON, LAUREN M (DPT)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:M
Last Name:WATSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:M
Other - Last Name:HAWKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 34669
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-0669
Mailing Address - Country:US
Mailing Address - Phone:402-932-6791
Mailing Address - Fax:
Practice Address - Street 1:6307 CENTER ST
Practice Address - Street 2:105
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-3458
Practice Address - Country:US
Practice Address - Phone:402-932-6791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010318A225100000X
WI12183-24225100000X
NE3521225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100239270Medicaid
WI830420083Medicare PIN
IN156522Medicare PIN
INM400055619Medicare PIN