Provider Demographics
NPI:1245191329
Name:ULRICH, LAINEY ELIZABETH (PTA)
Entity type:Individual
Prefix:
First Name:LAINEY
Middle Name:ELIZABETH
Last Name:ULRICH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12985 SW DAVID DR
Mailing Address - Street 2:
Mailing Address - City:LAKE SUZY
Mailing Address - State:FL
Mailing Address - Zip Code:34269-3754
Mailing Address - Country:US
Mailing Address - Phone:419-327-0678
Mailing Address - Fax:
Practice Address - Street 1:21281 GRAYTON TER
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33954-3109
Practice Address - Country:US
Practice Address - Phone:941-613-0919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-19
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA34435225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant