Provider Demographics
NPI:1124270616
Name:STARACE, LAUREN BETH
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:BETH
Last Name:STARACE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44927 GEORGE WASHINGTON BLVD
Mailing Address - Street 2:#210
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-4295
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44927 GEORGE WASHINGTON BLVD
Practice Address - Street 2:#210
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-4295
Practice Address - Country:US
Practice Address - Phone:571-291-9936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18432225100000X
NJ40QA01215900225100000X
CAPT36159225100000X
VA23052068132251P0200X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics