Provider Demographics
NPI:1396244539
Name:CALDWELL, LAUREN KATHRYNE (PT, DPT)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:KATHRYNE
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:GILLETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:930 BRICK RD
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-9513
Mailing Address - Country:US
Mailing Address - Phone:989-965-2163
Mailing Address - Fax:
Practice Address - Street 1:1234 E BROOMFIELD ST # A3
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-4491
Practice Address - Country:US
Practice Address - Phone:989-773-1333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501018080225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist