Lauren Takayesu, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

294454 Issued in CA

Practice address

USA Meddac
11050 Mount Belvedere Blvd
Fort Drum, NY 13602

Phone

(315) 772-2778

NPI assigned

Apr 10, 2018

Reactivated

Aug 5, 2025

Last updated

Aug 5, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1523318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754352000000",
    "number": "1851898431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "USA MEDDAC",
            "address_2": "11050 MOUNT BELVEDERE BLVD",
            "city": "FORT DRUM",
            "state": "NY",
            "postal_code": "13602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "USA MEDDAC",
            "address_2": "11050 MOUNT BELVEDERE BLVD",
            "city": "FORT DRUM",
            "state": "NY",
            "postal_code": "13602",
            "telephone_number": "315-772-2778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAKAYESU",
        "first_name": "LAUREN",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-10",
        "last_updated": "2025-08-05",
        "certification_date": "2021-04-13",
        "deactivation_date": "2025-06-23",
        "reactivation_date": "2025-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "294454",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Patrick Sweeney, PT
• Katelyn Joanna Sylvester, PHARMD, BCPS
• Justin Szucs
• Jeffrey M Szymanski, PA, MPAS, APA
• Bradley Alan Tait, MD
• Bryan Tappen, DMD
• Whitney Tarkington, RDH
• Katlyn Tavarres
• Allison Elizabeth Tempel, DMD
• Danielle Terrill, MD, MPH

• Physical Therapist in Fort Drum, NY
• Providers in Fort Drum, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.