Provider Demographics
NPI:1194979260
Name:GARAVUSO, LAUREN (MSPT)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:GARAVUSO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E 87TH ST
Mailing Address - Street 2:APT 23B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3203
Mailing Address - Country:US
Mailing Address - Phone:732-208-9578
Mailing Address - Fax:
Practice Address - Street 1:201 E 87TH ST
Practice Address - Street 2:APT 23B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-3203
Practice Address - Country:US
Practice Address - Phone:732-208-9578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-15
Last Update Date:2008-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026071-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics