Provider Demographics
NPI:1083158331
Name:LAWTHER, MICHAEL WADE (MS, ATC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WADE
Last Name:LAWTHER
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 W UTICA ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-1909
Mailing Address - Country:US
Mailing Address - Phone:412-303-6192
Mailing Address - Fax:
Practice Address - Street 1:20 ALUMNI ARENA
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14260-5001
Practice Address - Country:US
Practice Address - Phone:716-645-5138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer