Healthcare Provider Details

I. General information

NPI: 1801125588
Provider Name (Legal Business Name): LAWRENCE B. MICHAELSON P.T., DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 E MCKELLIPS RD SUITE 101
MESA AZ
85203-2721
US

IV. Provider business mailing address

1345 E MCKELLIPS RD SUITE 101
MESA AZ
85203-2721
US

V. Phone/Fax

Practice location:
  • Phone: 480-827-0495
  • Fax: 480-827-2534
Mailing address:
  • Phone: 480-827-0495
  • Fax: 480-827-2534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number8759
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: