Provider Demographics
NPI:1205260031
Name:BUTTENSCHON, LAUREN NICOLE (PT, DPT)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:NICOLE
Last Name:BUTTENSCHON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4937 SPRING ROAD
Mailing Address - Street 2:MADISON-ONEIDA BOCES
Mailing Address - City:VERONA
Mailing Address - State:NY
Mailing Address - Zip Code:13478
Mailing Address - Country:US
Mailing Address - Phone:315-361-5659
Mailing Address - Fax:
Practice Address - Street 1:4937 SPRING ROAD
Practice Address - Street 2:MADISON-ONEIDA BOCES
Practice Address - City:VERONA
Practice Address - State:NY
Practice Address - Zip Code:13478
Practice Address - Country:US
Practice Address - Phone:315-361-5659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036341225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist