MEDICARE: MATTHEW LAWRENCE DPT

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	225100000X	Physical Therapist	1328753	TX

General Provider Information

NPI Number	:	1710507835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW LAWRENCE DPT

Provider Business Mailing Address
First Line	:	1500 E RIVERSIDE DR APT 121
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78741-1132
Country	:	US
Telephone Number	:	330-310-7328
Fax Number	:

Provider Business Practice Location Address
First Line	:	3435 GREYSTONE DR STE 104
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-2363
Country	:	US
Telephone Number	:	512-394-7581
Fax Number	:

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

Provider Enumeration Date	:	04/18/2020
Last Update Date	:	04/18/2020

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