Provider Demographics
NPI:1194105528
Name:KEALY, LAUREN
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:KEALY
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 1:3900E MEXICO AVE 210
Mailing Address - Street 2:CENTERPOINT 1
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3943
Mailing Address - Country:US
Mailing Address - Phone:303-691-3733
Mailing Address - Fax:
Practice Address - Street 1:5043 AKRON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-3743
Practice Address - Country:US
Practice Address - Phone:202-367-2024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2015-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO132722251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic