Provider Demographics
NPI:1437401916
Name:LAWRENCE, BETTY JEAN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:JEAN
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:BETTY
Other - Middle Name:JEAN
Other - Last Name:MATHEWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:514 ALDER ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-3854
Mailing Address - Country:US
Mailing Address - Phone:843-902-4863
Mailing Address - Fax:
Practice Address - Street 1:514 ALDER ST
Practice Address - Street 2:SUITE 6
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-3854
Practice Address - Country:US
Practice Address - Phone:843-902-4863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMAS . 8158174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist