Provider Demographics
NPI:1023024999
Name:LAWRENCE, MARK T (PT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:T
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:7301 PEAK DR
Mailing Address - Street 2:150
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-9037
Mailing Address - Country:US
Mailing Address - Phone:702-804-0026
Mailing Address - Fax:702-243-4769
Practice Address - Street 1:8955 S PECOS RD
Practice Address - Street 2:1-A
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7156
Practice Address - Country:US
Practice Address - Phone:702-474-7212
Practice Address - Fax:702-474-7458
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-03-15
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Provider Licenses
StateLicense IDTaxonomies
NV0492225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1023024999Medicaid
NV1023024999Medicaid