Healthcare Provider Details

I. General information

NPI: 1699033308
Provider Name (Legal Business Name): LAWRENCE SPIEGEL DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 SAWGRASS CORPORATE PKWY MEDPRO HEALTHCARE STAFFING SUITE 100
SUNRISE FL
33323
US

IV. Provider business mailing address

4300 AURORA AVE N APT S402
SEATTLE WA
98103-7379
US

V. Phone/Fax

Practice location:
  • Phone: 954-739-4247
  • Fax: 800-370-0755
Mailing address:
  • Phone: 516-376-6677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number32022
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT60265996
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: