Provider Demographics
NPI:1275306516
Name:LAWRENCE, DOMINIQUE A (LMT)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:A
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 RUGG AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-4610
Mailing Address - Country:US
Mailing Address - Phone:740-616-6490
Mailing Address - Fax:
Practice Address - Street 1:693 HOPEWELL DR
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:OH
Practice Address - Zip Code:43056-1579
Practice Address - Country:US
Practice Address - Phone:740-616-6490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.019443225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist