Individual
LAUREN COPELAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
629 GALLAHER RD, KINGSTON, TN 37763-4215
(865) 376-3416
(865) 376-3532
Mailing address
629 GALLAHER RD, KINGSTON, TN 37763-4215
(865) 376-3416
(865) 376-3532
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
6640
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1316076268
NPI
TN
05
—
H445387
—
TN
Enumeration date
10/14/2013
Last updated
10/14/2013
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