Provider Demographics
NPI:1083673354
Name:LAWRENCE, AMBER DAWN (DPT)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:DAWN
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:AMBER
Other - Middle Name:DAWN
Other - Last Name:INGRAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:8590 DOVER DOWNS CT
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-2929
Mailing Address - Country:US
Mailing Address - Phone:402-490-8112
Mailing Address - Fax:
Practice Address - Street 1:8590 DOVER DOWNS CT
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-2929
Practice Address - Country:US
Practice Address - Phone:402-490-8112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2556225100000X
NE2391225100000X
VA2305208453225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI2556OtherPHYSICAL THERAPIST LICENSE - INACTIVE
VA2305208453OtherPHYSICAL THERAPIST LICENSE
NE2391OtherPHYSICAL THERAPIST LICENSE - INACTIVE