Individual
LAUREN LICHTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
363 MCKNIGHT AVE, WEST FORK, AZ 72774
(479) 839-3035
Mailing address
PO BOX 419, WEST FORK, AR 72774-0419
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
—
—
Other
Enumeration date
08/18/2020
Last updated
08/18/2020
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