Provider Demographics
NPI:1518378041
Name:LAWRENCE, AMANDA E (PT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:E
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6570
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85385-6570
Mailing Address - Country:US
Mailing Address - Phone:623-398-8072
Mailing Address - Fax:623-398-8235
Practice Address - Street 1:706 E BELL RD
Practice Address - Street 2:SUITE 121
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-6640
Practice Address - Country:US
Practice Address - Phone:602-795-8441
Practice Address - Fax:602-795-8447
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ10882225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist