Healthcare Provider Details

I. General information

NPI: 1184173874
Provider Name (Legal Business Name): HILLARY LAWRENCE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2016
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 33RD ST NW
CANTON OH
44709-3014
US

IV. Provider business mailing address

428 33RD ST NW
CANTON OH
44709-3014
US

V. Phone/Fax

Practice location:
  • Phone: 440-371-7832
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT016396
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: