Provider Demographics
NPI:1164654240
Name:MURRAY, LAWRENCE
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:MURRAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:LARRY
Other - Middle Name:
Other - Last Name:MURRAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:6659 KIMBALL DR
Mailing Address - Street 2:C-303
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-5137
Mailing Address - Country:US
Mailing Address - Phone:253-857-5437
Mailing Address - Fax:253-857-5497
Practice Address - Street 1:6659 KIMBALL DR
Practice Address - Street 2:C-303
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-5137
Practice Address - Country:US
Practice Address - Phone:253-857-5437
Practice Address - Fax:253-857-5497
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000032702251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7025612Medicaid