Provider Demographics
NPI:1215761085
Name:KOLLIGS, LAUREN (LMT)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:
Last Name:KOLLIGS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:KOLLIGS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAUREN KOLLIGS LMT
Mailing Address - Street 1:12 CANTERBURY DR
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-2306
Mailing Address - Country:US
Mailing Address - Phone:631-827-8213
Mailing Address - Fax:
Practice Address - Street 1:3400 NESCONSET HWY STE 104
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3327
Practice Address - Country:US
Practice Address - Phone:516-704-7447
Practice Address - Fax:516-734-6312
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015444225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist