Provider Demographics
NPI:1194957605
Name:DECICCO, LAUREN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:
Last Name:DECICCO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:311 S CYPRESS RD
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-7133
Mailing Address - Country:US
Mailing Address - Phone:954-781-7248
Mailing Address - Fax:
Practice Address - Street 1:311 S CYPRESS RD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-7133
Practice Address - Country:US
Practice Address - Phone:954-781-7248
Practice Address - Fax:954-781-7313
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist