Provider Demographics
NPI:1053799890
Name:FRYE, LAUREN ASHLEE (PTA)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ASHLEE
Last Name:FRYE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:FRYE
Other - Last Name:MUCKELVANEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:2820 US HIGHWAY 45 N
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TN
Mailing Address - Zip Code:38340-1322
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:45 FOREST CV
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-4366
Practice Address - Country:US
Practice Address - Phone:731-424-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5292225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant