Provider Demographics
NPI:1255662359
Name:ATKINS, LAUREN AMBER (PTA)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:AMBER
Last Name:ATKINS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5345 E HARMONY AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-5507
Mailing Address - Country:US
Mailing Address - Phone:928-231-1391
Mailing Address - Fax:
Practice Address - Street 1:5345 E HARMONY AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-5507
Practice Address - Country:US
Practice Address - Phone:928-231-1391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-29
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8512A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant