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NPI Code Detail

MEDICARE: AMANDA LARAE LAWRENCE PT

MEDICARE: AMANDA LARAE LAWRENCE PT
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
12251X0800XOrthopedic Physical TherapistPT3780OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14429092R2001OTHEROKBCBS OF OKLA

General Provider Information

NPI Number : 1255330080
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA LARAE LAWRENCE PT
Provider Business Mailing Address
First Line : 1200 CORPORATE DR
Second Line :
City : HOOVER
State : AL
Zip : 35242-2941
Country : US
Telephone Number : 423-777-6236
Fax Number :
Provider Business Practice Location Address
First Line : 2340 NW 32ND ST
Second Line :
City : NEWCASTLE
State : OK
Zip : 73065-6589
Country : US
Telephone Number : 405-396-3322
Fax Number : 405-392-3356
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2005
Last Update Date : 08/30/2023

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Directions to “ AMANDA LARAE LAWRENCE PT” Practice Location

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