Provider Demographics
NPI:1083715429
Name:HAM, LAWRENCE EDWARD (MS, PT)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:EDWARD
Last Name:HAM
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 S SOUTHEAST BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-3542
Mailing Address - Country:US
Mailing Address - Phone:509-532-0500
Mailing Address - Fax:509-532-8810
Practice Address - Street 1:3010 S SOUTHEAST BLVD STE G
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-3542
Practice Address - Country:US
Practice Address - Phone:509-532-0500
Practice Address - Fax:509-532-8810
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000022692251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2009197Medicaid
4531957OtherAETNA
WA0189664OtherDEPT OF LABOR & INDUSTRY