Provider Demographics
NPI:1417414590
Name:CONWAY, LAUREN MILLER (DPT)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:MILLER
Last Name:CONWAY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:CHRISTINE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1377 MOTOR PKWY STE 307
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5258
Mailing Address - Country:US
Mailing Address - Phone:757-932-4261
Mailing Address - Fax:631-580-5200
Practice Address - Street 1:439 CHANNEL RD STE 102
Practice Address - Street 2:
Practice Address - City:LAKE WYLIE
Practice Address - State:SC
Practice Address - Zip Code:29710-6101
Practice Address - Country:US
Practice Address - Phone:803-746-7800
Practice Address - Fax:803-670-3068
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP19235225100000X
PAPT027508225100000X
SC10007225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist