Provider Demographics
NPI:1811920200
Name:WERKHOVEN, LAUREN V (PT)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:V
Last Name:WERKHOVEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:V
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:73 NEWTON RD
Mailing Address - Street 2:STE 101
Mailing Address - City:PLAISTOW
Mailing Address - State:NH
Mailing Address - Zip Code:03865-2424
Mailing Address - Country:US
Mailing Address - Phone:978-388-7272
Mailing Address - Fax:978-388-7373
Practice Address - Street 1:607 BANTAM RD
Practice Address - Street 2:UNIT H
Practice Address - City:BANTAM
Practice Address - State:CT
Practice Address - Zip Code:06750-1601
Practice Address - Country:US
Practice Address - Phone:860-567-7787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007202225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004237948Medicaid
CT080007202CT08OtherANTHEM INDIV #
CT650001152OtherMEDICARE PTAN