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General NPI Number Information
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NPI Number | 1962934018
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Entity Type | Individual
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Provider Name | ANDREW LAWRENCE AT, ATC
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Gender | Male
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Dates
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Enumeration Date | 03/29/2017
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Last Update Date | 03/29/2017
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Provider Practice Location Address
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Address Line | 611 E PORTER ST
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City | ALBION
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State | MI
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Zip | 49224-1831
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Country | US
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Telephone | 517-629-0522
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Fax |
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Provider Business Mailing Address
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Address Line | 115 HART ST
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City | MARSHALL
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State | MI
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Zip | 49068-1823
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Country | US
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Telephone | 269-420-9669
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | L535716
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License Number State | MI
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