Provider Demographics
NPI:1528013398
Name:LAWLER, SHANE MICHAEL (PT)
Entity Type:Individual
Prefix:MR
First Name:SHANE
Middle Name:MICHAEL
Last Name:LAWLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3868 MEXICO RD
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303
Mailing Address - Country:US
Mailing Address - Phone:636-926-0408
Mailing Address - Fax:636-926-0295
Practice Address - Street 1:104 JUNGERMAN RD
Practice Address - Street 2:SUITE F
Practice Address - City:ST PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376
Practice Address - Country:US
Practice Address - Phone:636-926-2641
Practice Address - Fax:636-926-3385
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20001572312251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic