Provider Demographics
NPI:1023382488
Name:LAURENCE, GILLIAN (MPT)
Entity Type:Individual
Prefix:MS
First Name:GILLIAN
Middle Name:
Last Name:LAURENCE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 3RD ST NE
Mailing Address - Street 2:APT #3
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-1465
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1908 3RD STREET, NE
Practice Address - Street 2:APT #3
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1465
Practice Address - Country:US
Practice Address - Phone:202-321-2430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23911225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist