Provider Demographics
NPI:1396231791
Name:CORDOVA, LAUREN (DPT)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:
Last Name:CORDOVA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:CANADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 90007
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-9007
Mailing Address - Country:US
Mailing Address - Phone:270-780-2497
Mailing Address - Fax:
Practice Address - Street 1:165 NATCHEZ TRACE AVE STE 200
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103
Practice Address - Country:US
Practice Address - Phone:270-796-4698
Practice Address - Fax:270-782-3274
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007435225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist