Provider Demographics
NPI:1679729537
Name:DINICOLA, LAUREN (PHYSICAL THERAPIST,)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:DINICOLA
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 S. EASTERN AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-3345
Mailing Address - Country:US
Mailing Address - Phone:702-731-6873
Mailing Address - Fax:702-731-2565
Practice Address - Street 1:3650 S. EASTERN AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3345
Practice Address - Country:US
Practice Address - Phone:702-731-6873
Practice Address - Fax:702-731-2565
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2253225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist