Individual
LAUREN KOTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3101 PACKERLAND DR, GREEN BAY, WI 54313-6187
(920) 592-3845
Mailing address
PO BOX 19070, GREEN BAY, WI 54307-9070
(920) 496-4700
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
12532-24
WI
Other
Enumeration date
03/04/2014
Last updated
10/06/2020
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