Provider Demographics
NPI:1255330080
Name:LAWRENCE, AMANDA LARAE (PT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LARAE
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-2941
Mailing Address - Country:US
Mailing Address - Phone:423-777-6236
Mailing Address - Fax:
Practice Address - Street 1:2340 NW 32ND ST
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:OK
Practice Address - Zip Code:73065-6589
Practice Address - Country:US
Practice Address - Phone:405-396-3322
Practice Address - Fax:405-392-3356
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT37802251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4429092R2001OtherBCBS OF OKLA