MEDICARE: MR. LAWRENCE EDWARD HAM M.S., P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	PT00002269	WA
2	225100000X	Physical Therapist	PT00002269	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4531957	OTHER		AETNA
3	0189664	OTHER	WA	DEPT OF LABOR & INDUSTRY

General Provider Information

NPI Number	:	1083715429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LAWRENCE EDWARD HAM M.S., P.T.

Provider Business Mailing Address
First Line	:	3010 S SOUTHEAST BLVD STE G
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99223-3542
Country	:	US
Telephone Number	:	509-532-0500
Fax Number	:	509-532-8810

Provider Business Practice Location Address
First Line	:	3010 S SOUTHEAST BLVD STE G
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99223-3542
Country	:	US
Telephone Number	:	509-532-0500
Fax Number	:	509-532-8810

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	04/22/2021

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Directions to “ MR. LAWRENCE EDWARD HAM M.S., P.T.” Practice Location

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