Provider Demographics
NPI:1225552417
Name:PROENCA, LAUREN (PT, DPT, MSCS)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:PROENCA
Suffix:
Gender:F
Credentials:PT, DPT, MSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8645 N MILITARY TRL STE 401
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6295
Mailing Address - Country:US
Mailing Address - Phone:561-320-2702
Mailing Address - Fax:
Practice Address - Street 1:8645 N MILITARY TRL STE 401
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-6295
Practice Address - Country:US
Practice Address - Phone:561-320-2702
Practice Address - Fax:561-467-4179
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT32537225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist